1697 – Review of different minimally invasive therapeutic approaches for the management of patients with benign prostatic hyperplasia

Page last updated: 23 February 2022

Application Detail

Description of Medical Service

The benign prostatic hyperplasia (BPH) Review aims to review the safety, effectiveness and cost-effectivenss of different minimally invasive procedures funded on the Medicare Benefits Schedule (MBS), or proposed for funding on the MBS, for the treatment of BPH. Surgical therapy, transurethral resection of the prostate (TURP), is indicated for BPH patients with severe or high impact lower urinary tract symptoms. TURP is considered the gold standard treatment for BPH and is the most frequently used BPH procedure reimbursed on the MBS. The review will compare TURP with minimally invasive procedures that are used as an alternative to TURP including: endoscopic enucleation, prostatic urethral lift (PUL), transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA), for transurethral water vapour ablation (TUWA), visual laser ablation of the prostate (VLAP), and other BPH treatment (diathermy or cauterisation).

Description of Medical Condition

BPH, also called prostate enlargement, is a non-cancerous enlargement of the prostate gland, in which smooth muscle and epithelial cells proliferate, that occurs as a natural part of ageing. BPH may cause lower urinary tract symptoms either by directly obstructing the bladder outlet or by the increased smooth muscle tone and resistance within the enlarged gland. Symptoms may include increased frequency and urgency of urination, urinating at night, difficulty starting or stopping urination, weak stream, inability to urinate, and/or loss of bladder control.

Reason for Application

At the 79th MSAC meeting, MSAC deferred its consideration of two applications seeking MBS funding for two different minimally invasive procedures for the treatment of BPH. MSAC application 1586 sought the creation of a new MBS item for TUWA for the treatment of BPH. MSAC application 1612 proposed a fee increase for an existing MBS item 36811 for the PUL procedure for men with BPH. For both applications, MSAC noted there were significant uncertainties in the costs associated with each procedure, and requested the Department, in consultation with applicants and professional and consumer stakeholders, to undertake a review on the effectiveness (including short and long-term outcomes), safety, costs and cost-effectiveness of VLAP, PUL, TUWA, TURP, TUNA and any other minimally invasive procedures used to manage BPH. MSAC considered this review could also usefully garner information on: why urologists recommended certain procedures, what informs patient preferences for certain procedures, and long-term outcomes. MSAC considered that this review would allow MSAC to provide better advice to the Minister on which BPH procedures should be funded on the MBS and the appropriate fees for each procedure are.

Medical Service Type

Therapeutic technology

Previous Application Number/s

1014; 1076; 1518; 1586; and 1612
See also: EUnetHTA – Comparative effectiveness of surgical techniques and devices for the treatment of benign prostatic hyperplasia

Associated Documentation

Application Form

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Consultation Survey

Organsiations, consumers and carers are welcome to provide feedback to the Department outlining the key points that they wish MSAC to consider. Please provide consultation feedback via email to commentsMSAC@health.gov.au (and cc: SurgicalServices@health.gov.au), including the MSAC application number 1697 in the subject heading of your email.

PASC Consultation
Not applicable

MSAC Consultation
MSAC consultation input must be received by no later than Friday, 10 June 2022 for it to be considered by MSAC at its July 2022 meeting.

For further information please refer to PASC, ESC, MSAC Key Dates
For further information on the consultation process please refer to MSAC Consultation Process

PICO Confirmation

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Assessment Report

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Public Summary Document

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Meetings for this Application

PASC

Bypassed PASC

ESC

9-10 June 2022

MSAC

28-29 July 2022