UroLift® (Prostatic Urethral Lift) Shows Great Potential for Treatment of Enlarged Prostate

UroLift® is an innovative, cost-effective, short and non-invasive treatment for the common condition of Benign Prostatic Hyperplasia (BPH), in which an enlarged prostate can affect men aged 50+ years. The treatment is completed in less than 30 minutes, can prevent lengthy and unnecessary stays in hospital, and can target the problem area for patients without the need for cutting or removing tissue. By doing so, it produces better outcomes and faster healing, and reduced risk of post-operative complications.

NHS Trusts that have adopted UroLift® have indicated that each procedure has taken 25 minutes with the result that seven or eight procedures could potentially be completed in one afternoon, compared to a single procedure taking up to 72 minutes using current methods. Moreover, each patient can be treated as a day case, with no requirement for a hospital stay, and only one patient has required a follow-up appointment.

There is therefore great potential for cost savings to the NHS, and patients achieve rapid relief from symptoms which helps them to quickly return to normal daily activity. UroLift® is recommended by NICE (Medical Technology Guidance: MTG26), and more recently was referenced as a case study in the Accelerated Access Review Report as an innovative medical technology with cost-saving potential. Accordingly, UroLift® is now one of six innovations made eligible for the Innovation Technology Tariff.

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Benign Prostatic Hyperplasia (BPH) is a common, yet chronic, condition whereby an enlarged prostate can make it difficult for a male sufferer to pass urine. This can lead to urinary tract infections (UTIs), urinary retention, and in some cases, renal failure. Prevalence increases with advancing age, affecting more than one in three men in their 50s, and affecting 80% of men over 70. Drugs for BPH tend to be poorly tolerated and can cause undesirable side effects.

Men with moderate or severe symptoms are commonly offered a surgical procedure (Transurethral Resection of the Prostate (TURP) or laser treatment), which involves cutting away or removing existing tissue. This can lead to permanent side effects affecting sexual function, and persistent complications, placing further demands on the patient and the NHS.

There are approximately 20,000 TURP procedures each year (with an average inpatient stay of three days) costing the NHS £54 million. A further £109 million is spent on complications that require further episodes of hospital care.* In the North East regional alone, there are 1,425 BPH procedures performed each year (1225 TURP and 200 laser treatment procedures), with £5.4 million being spent on complications over a five year period (and more than 50% of these costs in the first year post-surgery).

*HES Data provided under a data sharing agreement from the Health and Social Care Information Centre via Harvey Walsh Ltd 2015, and costings are based on the National Schedule of Reference Costs.

Urolift: Before and After Illustration

Urolift: Before and After Illustration

Wessex AHSN, recognising the potential of UroLift® to improve patient outcomes and reduce NHS costs, worked with Neotract (the manufacturer of UroLift®) to develop a health economics approach that demonstrates benefits to each CCG individually, rather than relying upon clinical trial data extrapolated to a national view.

UroLift® has been assessed and included in NICE Medical Technology Guidance (MTG26), published in September 2015, and within the European Association of Urologists’ 2016 guidelines for the management of lower urinary tract symptoms of BPH, where it was awarded a 1A level of evidence.

UroLift® has been proven in multiple peer review clinical studies, with durability demonstrated over a time period of up to four years.

Urolift: Before and After Photo

Urolift: Before and After Photo

UroLift® is one of six innovations eligible for the Innovation and Technology Tariff (ITT). Unlike the other five technologies included within the ITT, prostatic urethral lift has been assigned a national tariff within the 2017/18 National Tariff Payment System, intended to avoid the need for multiple price negotiations between commissioners and providers, and between providers and the company.

UroLift® was designed to provide a minimally-invasive and durable solution for men with symptoms of BPH. By delivering the following, UroLift® provides solutions to several key challenges in the management of BPH: –

  • Short (less than 30 minutes duration) ambulatory procedure, performed under local anaesthetic or light sedation. Conversely, TURP requires 60 to 90 minutes to perform and requires a general anaesthetic
  • No overnight stay required
  • Minimally invasive – no cutting or removing of tissue, with minimal side effects and post-operative complications
  • No requirement for catheterisation thereby reducing the risk of catheter associated UTIs
  • Reduced requirement for outpatient follow-up appointments
  • Easy and rapidly deployable technology, with no capital outlay or specialist equipment required apart from the implants themselves
  • Minimal training requirements

Clinical opinion suggests that at least 40% of patients requiring surgery for BPH would be clinically eligible for UroLift®. Offering UroLift® as an alternative to TURP or laser treatment realises the following: –

Benefits to patients
  • Rapid and sustained improvement in symptoms and flow
  • Improved safety and side effect profile compared with current surgical treatments
  • Preservation of sexual function
  • Significantly reduced post-operative complications, resulting in a more rapid return to daily living when compared with TURP
Benefits to the NHS

Adoption in 40% of surgical patients has the potential to realise the following: –

  • Improved bed capacity – it is estimated that  over 1,700 bed days are saved per year in the North East and North Cumbria (NENC) region, and that 24,000 bed days per year are saved nationally
  • Improved theatre capacity – it is estimated to save over 475 hours of theatre time in the NENC region, and over 8,000 hours of theatre time nationally
  • Reduced requirement for outpatient follow-up appointments, potentially saving at least 1 follow-up appointment per patient. This equates to more than 570 appointments in the NENC region and over 8,000 appointments nationally
  • Reduced risk of complications – this could potentially save costs of over £1.1 million in the five year post-surgery period across the NENC region, with £550,000 saved in the first year. Scaled nationally, these savings are expected to exceed £22m as a conservative calculation.
  • Reduced waiting times
  • Reduced delays in transfer of care

The long-term follow-up of patients has indicated improved quality of life and continued symptom control.  The surgical retreatment rate after five years was 13.6%, which translates to 2-3% per year for UroLift® compared to 1-2% per year for the TURP procedure.

UroLift® addresses the NHS England priority of funding and efficiency. The Accelerated Access Review (AAR) Report highlighted UroLift® as “an innovative medical technology with cost saving potential.” The Accelerated Access Partnership aims to build upon the Five Year Forward View infrastructure and collaborate with AHSNs, aligning to existing programmes such as New Models of Care, RightCare, the NHS Test Beds and the Carter Implementation Programme.

In the MTG 26, NICE stated that UroLift® “may result in productivity savings for the NHS Trusts from reduced length of stay in hospital and the associated inpatient resource use (such as theatre operating time and associated staffing costs and consumables). It also helps improve productivity (saving physician and other healthcare professionals’ time) within outpatient settings due to reduced post-discharge follow-ups both in Primary Care settings and in an outpatient setting.”

Nationally, over 40 NHS Trusts have currently adopted UroLift®, with others considering adoption. Three NHS Trusts have published details of their experiences so far in the NICE Shared Learning Programme: –

  • Adoption of UroLift for Treating Lower Urinary Tract Symptoms of BPH at St Helens and Knowsley NHS Trust (https://www.nice.org.uk/sharedlearning/insights-from-the-nhs-adoption-of-urolift-for-treating-lower-urinary-tract-symptoms-of-benign-prostatic-hyperplasia-at-st-helens-and-knowsley-teaching-hospital-nhs-trust)
  • Adoption of UroLift for Treating LUTS of BPH at Frimley Park Hospital (https://www.nice.org.uk/sharedlearning/insights-from-the-nhs-adoption-of-urolift-for-treating-lower-urinary-tract-symptoms-of-benign-prostatic-hyperplasia-at-frimley-park-hospital)
  • UroLift Using Local Anaesthesia in the Ambulatory and One-Stop Urology Service at Norfolk and Norwich University Hospital NHS Trust (https://www.nice.org.uk/sharedlearning/adoption-of-urolift-procedure-an-ambulatory-pathway-for-patients-suffering-from-lower-urinary-tract-symptoms-of-benign-prostatic-hyperplasia)

Currently, in the NENC region, procedures are carried out by City Hospitals Sunderland NHS Foundation Trust, The Newcastle upon Tyne Hospitals NHS Foundation Trust and South Tees Hospitals NHS Foundation Trust.  The AHSN NENC will be working with CCGs and other NHS Trusts across the region to encourage full adoption of this beneficial procedure.