Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
J Urol. 2010 Apr;183(4):1469-73. doi: 10.1016/j.juro.2009.12.020. Epub 2010 Feb 20.
Laser procedures to treat symptomatic benign prostatic hyperplasia are becoming more common despite concern for potentially increasing cost burdens often associated with new technologies.
Actual costs associated with photoselective laser vaporization prostatectomy and transurethral prostate resection were measured using the EPSi and TSI (Eclipsys) hospital cost accounting systems at 2 large tertiary referral centers for the first 12 months that GreenLight HPS was performed. Only patients who presented for photoselective laser vaporization prostatectomy or transurethral prostate resection as the principal treatment during the hospital visit were included in study.
A total of 250 men underwent transurethral prostate resection and 220 underwent photoselective laser vaporization prostatectomy, including 194 (78%) and 209 (95%), respectively, treated on an outpatient basis with less than 23 hours of hospitalization. Overall costs of laser vaporization were lower than those of transurethral prostate resection ($4,266 +/- $1,182 vs $5,097 +/- $5,003, p = 0.01). Average inpatient length of stay was also longer in the resection group.
The actual costs of photoselective laser vaporization prostatectomy at our affiliated hospitals are lower than those of transurethral prostate resection. The primary reason is likely that most patients who undergo laser vaporization are treated on an outpatient basis compared to those who undergo resection. While significant complications are uncommon, those that prolong inpatient hospitalization such as hyponatremia (transurethral resection syndrome), which is associated with transurethral prostate resection but not with photoselective laser vaporization prostatectomy, can add substantial expense. Further studies are warranted to investigate these findings on a broader scale.
尽管对新技术通常会增加成本负担存在担忧，但治疗有症状的良性前列腺增生的激光手术越来越普遍。
在两家大型三级转诊中心，使用 EPSi 和 TSI（Eclipsys）医院成本核算系统，在首次进行 GreenLight HPS 的 12 个月内，测量了经尿道前列腺切除术和经尿道前列腺激光汽化切除术的实际成本。只有在就诊期间作为主要治疗方法接受经尿道前列腺切除术或经尿道前列腺激光汽化切除术的患者才被纳入研究。
共有 250 名男性接受了经尿道前列腺切除术，220 名男性接受了经尿道前列腺激光汽化切除术，其中分别有 194 名（78%）和 209 名（95%）接受了门诊治疗，住院时间少于 23 小时。激光汽化的总费用低于经尿道前列腺切除术（4266 美元±1182 美元对 5097 美元±5003 美元，p=0.01）。切除组的平均住院时间也较长。
我们附属医院的经尿道前列腺激光汽化切除术的实际成本低于经尿道前列腺切除术。主要原因可能是与经尿道前列腺切除术相比，大多数接受激光汽化治疗的患者都是门诊治疗。尽管严重并发症并不常见，但那些延长住院时间的并发症，如低钠血症（经尿道前列腺切除术后综合征），与经尿道前列腺切除术有关，而与经尿道前列腺激光汽化切除术无关，可能会增加大量费用。需要进一步的研究来更广泛地调查这些发现。
