{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:36:17Z","timestamp":1792089377648,"version":"4.4.0"},"reference-count":42,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SJU"],"abstract":"<jats:p>Objectives: This capacity and budget impact analysis considers implications of offering a more diversified benign prostate enlargement (BPE) surgical care offering from a healthcare payer perspective in Sweden, Denmark, Norway and Finland.\nMethods: A cohort simulation model compares 4-year treatment costs and capacity impact, including hospital bed-days and operating time, with Transurethral Resection of the Prostate (TURP), Holmium Laser Enucleation of the Prostate (HoLEP) using MOSES\u2122Technology, photoselective vaporisation of the prostate (PVP) and Rez\u016bm\u2122 Water Vapour Therapy (WVTT). Current treatment choice is compared to a hypothetical scenario, where TURP-proportion is reduced to 50% and volumes of HoLEP, PVP and WVTT are increased. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) considered uncertainty when varying all model inputs individually and simultaneously.\nResults: Reducing the proportion of TURP to 50% and shifting towards a more diversified surgical offering could save 590 bed-days, 2,281 theatre hours and SEK 14,020,153 in Sweden; 343 bed-days, 1,248 theatre hours and DKK 10,493,266 in Denmark; 267 bed-days, 1,032 theatre hours and NOK 9,329,844 in Norway and 576 bed-days, 1,181 theatre hours and 1,059,528\u20ac in Finland per year. WVTT emerged as the lowest-cost procedure in all scenarios. Both DSAs and PSAs demonstrated outcome robustness.\nConclusion: The adoption of a more diversified surgical care offering for patients with BPE in the Nordics may free theatre time and hospital bed-days and create meaningful cost-savings, which off-set higher initial device cost. Economic considerations should not constitute a barrier to the adoption of a patient-centric surgical care offering for BPE patients in the Nordics.<\/jats:p>","DOI":"10.2340\/sju.v60.44243","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T11:05:49Z","timestamp":1756897549000},"page":"164-172","source":"Crossref","is-referenced-by-count":1,"title":["Expanding treatments for lower urinary tract symptoms, secondary to benign prostatic enlargement. A capacity and budget impact analysis in four Nordic countries"],"prefix":"10.2340","volume":"60","author":[{"given":"Deirdre","family":"Blissett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Sagen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Espen","family":"Kvan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Souvleros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Pogodin-Hannolainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Spies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bruno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"125263","doi-asserted-by":"crossref","unstructured":"Stranne J, Damber J-E, Fall M, et al. One-third of the Swedish male population over 50 years of age suffers from lower urinary tract symptoms. Scand J Urol Nephrol. 2009;43(3):199\u2013205. https:\/\/doi.org\/10.1080\/00365590902833747","DOI":"10.1080\/00365590902833747"},{"key":"125264","doi-asserted-by":"crossref","unstructured":"Andersson SO, Rashidkhani B, Karlberg L, et al. Prevalence of lower urinary tract symptoms in men aged 45\u201379 years: a population\u2010based study of 40 000 Swedish men. BJU Int. 2004;94(3):327\u2013331. https:\/\/doi.org\/10.1111\/j.1464-410X.2004.04930.x","DOI":"10.1111\/j.1464-410X.2004.04930.x"},{"key":"125265","doi-asserted-by":"crossref","unstructured":"Miernik A, Fritzsche J, Libutzki B, et al. Real-world data and treatment patterns of patients with lower urinary tract symptoms due to benign prostatic hyperplasia in Germany: an observational study using health insurance claims data. World J Urol. 2021;39:4381\u20134388. https:\/\/doi.org\/10.1007\/s00345-021-03787-2","DOI":"10.1007\/s00345-021-03787-2"},{"key":"125266","doi-asserted-by":"crossref","unstructured":"Oelke M, Bachmann A, Descazeaud A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64(1):118\u2013140. https:\/\/doi.org\/10.1016\/j.eururo.2013.03.004","DOI":"10.1016\/j.eururo.2013.03.004"},{"key":"125267","doi-asserted-by":"crossref","unstructured":"Gravas S, Gacci M, Gratzke C, et al. Summary paper on the 2023 European Association of Urology guidelines on the management of non-neurogenic male lower urinary tract symptoms. Eur Urol. 2023;84(2):207\u2013222. https:\/\/doi.org\/10.1016\/j.eururo.2023.04.008","DOI":"10.1016\/j.eururo.2023.04.008"},{"key":"125268","doi-asserted-by":"crossref","unstructured":"Gravas S, Malde S, Cornu J-N, et al. From BPH to male LUTS: a 20-year journey of the EAU guidelines. Prostate Cancer Prostatic Dis. 2024;27(1):48\u201353. https:\/\/doi.org\/10.1038\/s41391-023-00700-3","DOI":"10.1038\/s41391-023-00700-3"},{"key":"125269","doi-asserted-by":"crossref","unstructured":"Turney B, Wetterauer C, Sato R, et al. Changing trends in the surgical management of BPO in Europe. Eur Urol. 2024;85:S901. https:\/\/doi.org\/10.1016\/S0302-2838(24)00745-0","DOI":"10.1016\/S0302-2838(24)00745-0"},{"key":"125270","unstructured":"Landspatientregisteret: Avanceret udtr\u00e6k [Internet]. Sundhetsdata-Styrelsen; 2024. Available from: https:\/\/www.esundhed.dk\/Emner\/Operationer-og-diagnoser\/Landspatientregisteret-Avanceret-udtraek#tabpanelFE2A577AEAAA41EE88D48460C9B1A8DD"},{"key":"125271","unstructured":"Toimenpiteiden lukum\u00e4\u00e4r\u00e4 vuosittain \u2013 THL kuutio- ja tiivistek\u00e4ytt\u00f6liittym\u00e4. 2024."},{"key":"125272","unstructured":"Helsedirektoratet. Aktivitet i somatiske sykehus, spesialisthelsetjenesten. Folkehelseinstituttet, Oslo:2024."},{"key":"125273","unstructured":"Statistikomr\u00e5den. Statistical database. D\u00f6dsorsaker. Stockholm: Socialstyrelsen; 2024."},{"key":"125274","unstructured":"Rezum for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia. [Medical Technology Guidance MTG49]. Na-tional Institute of Health and Care Excellence, London."},{"key":"125275","doi-asserted-by":"crossref","unstructured":"Lourenco T, Armstrong N, N\u2019dow J, et al. Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement. Health Technol Assess. 2008;12(35):1\u2013146. https:\/\/doi.org\/10.3310\/hta12350","DOI":"10.3310\/hta12350"},{"key":"125276","doi-asserted-by":"crossref","unstructured":"Rosen R, Altwein J, Boyle P, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003;44(6):637\u2013649. https:\/\/doi.org\/10.1016\/j.eururo.2003.08.015","DOI":"10.1016\/j.eururo.2003.08.015"},{"key":"125277","doi-asserted-by":"crossref","unstructured":"Eredics K, Wachabauer D, R\u00f6thlin F, et al. Reoperation rates and mortality after transurethral and open prostatectomy in a long-term nationwide analysis: have we improved over a decade? Urology. 2018;118:152\u2013157. https:\/\/doi.org\/10.1016\/j.urology.2018.04.032","DOI":"10.1016\/j.urology.2018.04.032"},{"key":"125278","doi-asserted-by":"crossref","unstructured":"Alexander CE, Scullion MM, Omar MI, et al. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev. 2019;12:CD009629. https:\/\/doi.org\/10.1002\/14651858.CD009629.pub4","DOI":"10.1002\/14651858.CD009629.pub4"},{"key":"125279","doi-asserted-by":"crossref","unstructured":"Bachmann A, Tubaro A, Barber N, et al. A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLI-ATH study. J Urol. 2015;193(2):570\u2013578. https:\/\/doi.org\/10.1016\/j.juro.2014.09.001","DOI":"10.1016\/j.juro.2014.09.001"},{"key":"125280","doi-asserted-by":"crossref","unstructured":"Yilmaz M, Karaaslan M, Aybal HC, et al. Laser enucleation of the prostate in men with very large glands\u2265 175 ml: a systematic review. Ann Med Surg. 2022;80:104279. https:\/\/doi.org\/10.1016\/j.amsu.2022.104279","DOI":"10.1016\/j.amsu.2022.104279"},{"key":"125281","doi-asserted-by":"crossref","unstructured":"McVary KT, Gittelman MC, Goldberg KA, et al. Final 5-year outcomes of the multicenter randomized sham-controlled trial of a water va-por thermal therapy for treatment of moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2021;206(3):715\u2013724. https:\/\/doi.org\/10.1097\/JU.0000000000001778","DOI":"10.1097\/JU.0000000000001778"},{"key":"125282","doi-asserted-by":"crossref","unstructured":"Cornu J-N, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following tran-surethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066\u20131096. https:\/\/doi.org\/10.1016\/j.eururo.2014.06.017","DOI":"10.1016\/j.eururo.2014.06.017"},{"key":"125283","doi-asserted-by":"crossref","unstructured":"Kavoussi NL, Nimmagadda N, Robles J, et al. MOSESTM technology for holmium laser enucleation of the prostate: a prospective double-blind randomized controlled trial. J Urol. 2021;206(1):104\u2013108. https:\/\/doi.org\/10.1097\/JU.0000000000001693","DOI":"10.1097\/JU.0000000000001693"},{"key":"125284","doi-asserted-by":"crossref","unstructured":"McVary KT, Gange SN, Gittelman MC, et al. Minimally invasive prostate convective water vapor energy ablation: a multicenter, random-ized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2016;195(5):1529\u20131538. https:\/\/doi.org\/10.1016\/j.juro.2015.10.181","DOI":"10.1016\/j.juro.2015.10.181"},{"key":"125285","doi-asserted-by":"crossref","unstructured":"Roehrborn CG, Gange SN, Gittelman MC, et al. Convective thermal therapy: durable 2-year results of randomized controlled and prospec-tive crossover studies for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. J Urol. 2017;197(6):1507\u20131516. https:\/\/doi.org\/10.1016\/j.juro.2016.12.045","DOI":"10.1016\/j.juro.2016.12.045"},{"key":"125286","doi-asserted-by":"crossref","unstructured":"Gauhar V, Gilling P, Pirola GM, et al. Does MOSES technology enhance the efficiency and outcomes of standard holmium laser enucleation of the prostate? Results of a systematic review and meta-analysis of comparative studies. Eur Urol Focus. 2022;8(5):1362\u20131369. https:\/\/doi.org\/10.1016\/j.euf.2022.01.013","DOI":"10.1016\/j.euf.2022.01.013"},{"key":"125287","doi-asserted-by":"crossref","unstructured":"Yin L, Teng J, Huang C-J, et al. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic re-view and meta-analysis of randomized controlled trials. J Endourol. 2013;27(5):604\u2013611. https:\/\/doi.org\/10.1089\/end.2012.0505","DOI":"10.1089\/end.2012.0505"},{"key":"125288","doi-asserted-by":"crossref","unstructured":"Miner M, Rosenberg MT, Perelman MA. Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function. Clin Therap. 2006;28(1):13\u201325. https:\/\/doi.org\/10.1016\/j.clinthera.2006.01.004","DOI":"10.1016\/j.clinthera.2006.01.004"},{"key":"125289","doi-asserted-by":"crossref","unstructured":"Komura K, Inamoto T, Takai T, et al. Incidence of urethral stricture after bipolar transurethral resection of the prostate using TUR is: Re-sults from a randomised trial. BJU Int. 2015;115(4):644\u2013652. https:\/\/doi.org\/10.1111\/bju.12831","DOI":"10.1111\/bju.12831"},{"key":"125290","doi-asserted-by":"crossref","unstructured":"Bachmann A, Tubaro A, Barber N, et al. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial\u2014the GOLIATH study. Eur Urol. 2014;65(5):931\u2013942. https:\/\/doi.org\/10.1016\/j.eururo.2013.10.040","DOI":"10.1016\/j.eururo.2013.10.040"},{"key":"125291","doi-asserted-by":"crossref","unstructured":"Johnston M, Shah T, Emara A, et al. MP01-03 Rez\u016bm water vapour ablation therapy for benign prostatic hyperplasia: initial results from the United Kingdom. J Urol. 2019;201:e1\u2013e2. https:\/\/doi.org\/10.1097\/01.JU.0000554867.66478.23","DOI":"10.1097\/01.JU.0000554867.66478.23"},{"key":"125292","doi-asserted-by":"crossref","unstructured":"Qiu T, Aball\u00e9a S, Pochopie\u0144, M, et al. A systematic review on the appropriate discounting rates for the economic evaluation of gene ther-apies: whether a specific approach is justified to tackle the challenges? Int J Technol Assess Health Care. 2024;40(1):e23. https:\/\/doi.org\/10.1017\/S0266462324000096","DOI":"10.1017\/S0266462324000096"},{"key":"125293","doi-asserted-by":"crossref","unstructured":"Salmivalli A, Bostr\u00f6m P, Nurminen P, et al. National trends of surgery for benign prostatic hyperplasia in Finland. Scand J Urol. 2024;59:70\u201375. https:\/\/doi.org\/10.2340\/sju.v59.32425","DOI":"10.2340\/sju.v59.32425"},{"key":"125294","unstructured":"Solholm V. Komplikasjoner og liggetid etter urologisk kirurgi. 2016."},{"key":"125295","doi-asserted-by":"crossref","unstructured":"Sagen E, Javid R, Liivrand L, et al. Patient related factors affecting in-hospital costs of a TURP procedure. Scand J Urol. 2021;55(4):324\u2013330. https:\/\/doi.org\/10.1080\/21681805.2021.1893380","DOI":"10.1080\/21681805.2021.1893380"},{"key":"125296","unstructured":"Sundhetstyrelsen. Dagkirurgi i Danmark, Status og udviklingsmuligheder. E.F. SYGEHUSE, Copenhagen."},{"key":"125297","doi-asserted-by":"crossref","unstructured":"Forsmark A, Gehrman J, Angenete E, et al. Health economic analysis of open and robot-assisted laparoscopic surgery for prostate cancer within the prospective multicentre LAPPRO trial. Eur Urol. 2018;74(6):816\u2013824. https:\/\/doi.org\/10.1016\/j.eururo.2018.07.038","DOI":"10.1016\/j.eururo.2018.07.038"},{"key":"125298","unstructured":"XprESS multi sinus dilation system for treating chronic sinusitis. Sodra Regionvardsnamnden. Medical technologies guidance [MTG30], Lund 2016."},{"key":"125299","unstructured":"The PLASMA system for transurethral resection and haemostasis of the prostate. NICE National Institute of Health and Care Excellence; London, UK: 2021."},{"key":"125300","unstructured":"Regionala priser och ers\u00e4ttningar f\u00f6r s\u00f6dra Sjukv\u00e5rdsregionen. Sodra Regionvardsnamnden: 2020."},{"key":"125301","doi-asserted-by":"crossref","unstructured":"Gilpin L, Zekan D, Baugh B, et al. Evaluating the efficacy of employing local anesthetic prostatic blocks during Rezum procedure. Cureus. 2022;14(9):e29598. https:\/\/doi.org\/10.7759\/cureus.29598","DOI":"10.7759\/cureus.29598"},{"key":"125302","doi-asserted-by":"crossref","unstructured":"Khadhouri S, Guillaumier S, Drummond L, et al. Feasibility of outpatient daycase local anaesthestic Rez\u016bm\u2122 without sedation. BMC Urol. 2024;24(1):80. https:\/\/doi.org\/10.1186\/s12894-024-01471-2","DOI":"10.1186\/s12894-024-01471-2"},{"key":"125303","doi-asserted-by":"crossref","unstructured":"Wahba R, Urbanski A, Datta R, et al. Operating room time savings in Germany-and UK-based hospitals with 3D-VS. 2D-imaging technology in laparoscopic surgery: Meta analysis and budget impact model\u2013Health economic evaluation. Int J Surg. 2022;102:106643. https:\/\/doi.org\/10.1016\/j.ijsu.2022.106643","DOI":"10.1016\/j.ijsu.2022.106643"},{"key":"125304","unstructured":"InEK Datenbrowser. Datenjahr 2023, I.f.d.E.i.K. (InEK), Editor. Institut f\u00fcr das Entgeltsystem im Krankenhaus (InEK), Siegburg, Germany."}],"container-title":["Scandinavian Journal of Urology"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/download\/44243\/51298","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/download\/44243\/51298","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T11:06:00Z","timestamp":1756897560000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/view\/44243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":42,"URL":"https:\/\/doi.org\/10.2340\/sju.v60.44243","relation":{},"ISSN":["2168-1813"],"issn-type":[{"value":"2168-1813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]}}}