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Cost Comparison of Different Transperineal Prostate Biopsy Methods

By GU Oncology Now Editors - December 1, 2021

To evaluate whether transperineal prostate biopsy (TP-Bx) was advantageous versus standard transrectal prostate biopsy (TR-Bx), Leonardo Borregales, MD, from the Department of Urology at New York Presbyterian Hospital, and collaborators performed a cost analysis using time-driven activity-based costing methodology on three methods of TP-Bx: free-hand transperineal prostate biopsy with local anesthesia (fTPLA), grid-based transperineal prostate biopsy with local anesthesia (gbTPLA), and transperineal prostate biopsy with sedation (TPBS).

The report, presented at the 22nd Annual Meeting from the Society of Urologic Oncology, showed that methods using local anesthesia were safe and approximately 50% less expensive than methods requiring sedation. They theorized that increased short-term spending on disposables for fTPLA and gbTPLA could be offset by the absence of post-biopsy infections seen in TR-Bx. The authors also noted that procedure length was shorter in fTPLA than in gbTPLA, however the differences in total time in hospital and total cost for the patient between the two methods did not reach statistical significance.

The analysis estimated direct and indirect costs based on complications data and demographic, procedural, and pathologic variables from 152 men undergoing MRI-targeted TP-Bx. The complication rate was 0%, 2.6%, and 6.1% for fTPLA, gbTPLA, and TPBS, respectively. Only one infectious complication was reported in the sedation cohort. Costing analysis demonstrated comparative total costs of $1141.64 for fTPLA, $961.64 for the gbTPLA, and $2208.16 for TPBS. Overhead costs of operating and recovery rooms drove the cost differences between the methods. Relative costs of disposables for all TP-bx fluctuated between 3-22% (absolute price range: $80.53–$260.53).

According to the authors, the findings ultimately provide support for the adoption of TP-Bx with local anesthesia as a less expensive method of prostate cancer diagnosis versus TR-Bx. “Further research into cost-effective of TP-Bx after accounting for differences in procedure reimbursement and post-biopsy complications rates is needed,” closed Dr. Borregales.

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