4 NHS considerations

4 NHS considerations

System impact

4.1 The company claimed that using the UroLift system would reduce hospital length of stay and inpatient resource use, because it can be done as a day procedure. It also claimed that by using the UroLift system, patients would need fewer follow‑up visits after being discharged and that there would also be savings associated with a reduced need to treat complications. The company also claimed that using the UroLift system could lead to reduced costs from avoiding conditions that may result from men delaying treatment because they are unwilling to risk sexual dysfunction after transurethral resection of the prostate (TURP) and holmium laser enucleation (HoLEP).

4.2 All the expert advisers stated that training was needed to use the UroLift system. Three of the experts referred to the training provided by the company, which includes a training simulator for the device. Most of the experts stated that simulator training and subsequent mentoring were needed.

4.3 The company submission stated that using the UroLift system would allow day surgery and outpatient care rather than inpatient treatment. The External Assessment Centre developed a scenario, based on information from expert advisers who used the technology, which explored the costs and benefits of using the UroLift system in a day‑surgery unit (see section 5.9).

Committee considerations

4.4 The Committee was advised that UroLift implants do not preclude the use of other surgical procedures that may be needed subsequently. Clinical experts also stated that UroLift implants are easily removed.

4.5 The Committee noted that there was uncertainty about the duration of symptom control after using the UroLift system, but it considered that the current evidence and advice indicated that benefits would be sufficiently prolonged to support adoption of the procedure (see section 3.34).

4.6 The Committee noted that most of the clinical evidence was based on inpatient treatment and this was reflected in the cost model presented by the company. The External Assessment Centre was advised by clinical experts that the UroLift system could be used in day surgery, and that some NHS hospitals already had implemented this approach. The clinical experts confirmed that there was an increasing trend to use the device as a day‑surgery procedure. The Committee concluded that use of the UroLift system was likely to take place in day‑surgery units in the NHS.

4.7 The Committee recognised the need for training to use the UroLift system and that there is a learning curve associated with its use. It was advised that procedure times and numbers of implants used both decrease with experience, and that increasing experience and confidence with the procedure may enable it to be done under local anaesthetic and without the use of a catheter. Based on all this advice, the Committee concluded that the cost savings associated with the use of the UroLift system may increase as surgeons become more experienced.

4.8 The company suggested that, in the future, the UroLift system might be used earlier in the care pathway as an alternative to medication. The Committee noted that this is outside the scope of the current evaluation. It considered that earlier use of the device in the care pathway might form part of a future evaluation with the development of a more mature evidence base for the UroLift system.

  • National Institute for Health and Care Excellence (NICE)