OBJECTIVE: To determine the cost-effectiveness of the current 'gold standard' 
operation of transurethral resection of the prostate (TURP) compared to the new 
laser technique of thulium laser transurethral vaporesection of the prostate 
(ThuVARP) in men with benign prostatic obstruction (BPO) within the UK National 
Health Service (NHS).
PATIENTS AND METHODS: The trial was conducted across seven UK centres (four 
university teaching hospitals and three district general hospitals). A total of 
410 men aged ≥18 years presenting with either bothersome lower urinary tract 
symptoms (LUTS) or urinary retention secondary to BPO, and suitable for surgery, 
were randomised (whilst under anaesthetic) 1:1 to receive the TURP or ThuVARP 
procedure. Resource use in relation to the operation, initial inpatient stay, 
and subsequent use of NHS services was collected for 12 months from 
randomisation (equivalent to primary effectiveness outcome) using hospital 
records and patient questionnaires. Resources were valued using UK reference 
costs. Quality adjusted life years (QALYs) were calculated from the EuroQoL five 
Dimensions five Levels (EQ-5D-5L) questionnaire completed at baseline, 3- and 
12-months. Total adjusted mean costs, QALYs and incremental Net Monetary Benefit 
statistics were calculated: cost-effectiveness acceptability curves and 
sensitivity analyses addressed uncertainty.
RESULTS: The total adjusted mean secondary care cost over the 12 months in the 
TURP arm (£4244) was £9 (95% CI -£376, £359) lower than the ThuVARP arm (£4253). 
The ThuVARP operation took on average 21 min longer than TURP. The adjusted mean 
difference of QALYs (0.01 favouring TURP, 95% CI -0.01, 0.04) was similar 
between the arms. There is a 76% probability that TURP is the cost-effective 
option compared with ThuVARP at the £20 000 per QALY willingness to pay 
threshold used by National Institute for Health and Care Excellence (NICE).
CONCLUSION: One of the anticipated benefits of the laser surgery, reduced length 
of hospital stay with an associated reduction in cost, did not materialise 
within the study. The longer duration of the ThuVARP procedure is important to 
consider, both from a patient perspective in terms of increased time under 
anaesthetic, and from a service delivery perspective. TURP remains a highly 
cost-effective treatment for men with BPO.