Finding a balance between innovation and affordability
At EAU25, experts explored strategies to balance innovation and affordability in urology, with growing issues of an aging popultion, demographic/equality in healthcare, as well as sustainability pressures.
Prof. Joost Boormans (NL) and Dr. Gianluca Giannarini (IT) chaired the Plenary Session ‘Novel technologies in urology: Affordability vs. benefits’, where Dr. Montserrat Daban (ES) addressed the pressing healthcare challenges in Europe. In her presentation, ‘A perilous blend: The challenge of an ageing population, an expanding arsenal of expensive treatments, and scarce resources’, she outlined key issues and potential solutions.
Dr. Daban: “The EU population is expected to rise from 449 million people in 2022 to a peak of 453 million people in 2026, with the old-age dependency ratio rising sharply in all Member States over the coming decades.”
She also highlighted inequalities among countries, referencing to Spain and the link between healthcare expenditure and tax collection/politics. Also, the density of active health professionals varies five-fold among Member States, which can lead to disparities in access to healthcare services and contribute to health inequalities.
Dr. Daban cited several calls to action for change or development, including the European Commission, which has established a forum called ‘Active and Healthy Living in the Digital World. This is a hub connecting European citizens, innovators, healthcare providers, researchers, and policymakers to share best practices, innovations, and policies for healthy living and aging with digital tools. Innovation such as artificial intelligence (AI). An example of AI innovation is the Health Reform Tracker, which offers a comprehensive overview of health reforms across 30+ countries in the WHO European Region and North America.
Calculating the benefits versus cost
“Cost effectiveness analysis are used globally to shape health policy and access to medical interventions”, stated Prof. David D’Andrea (AT) in his lecture, ‘How to measure cost-effectiveness in urological healthcare’. He outlined cost effectiveness analysis based on Quality Adjusted Life Years (QALY), which is calculated using utility value and time. “This method account for all subsequent treatments of a patient over time.” Proceeding this analysis, the Incremental Cost Effectiveness Ratio (ICER) can be determined by the change and cost and QALY (which gives you the difference in outcome). Another key factor in this methodology is the cost threshold from health budgets (willingness to pay).
Prof. D’Andrea highlighted four key take-home messages regarding cost effectiveness: balancing efficacy, cost, and quality of life; the role of cost-effectiveness in clinical decision-making; bridging cost-effectiveness with real-world practice; and the limitations of the cost effectiveness analysis (such as data uncertainty and generalisability).
Novel MISTs
In his presentation ‘How effective are MISTs for BPO?’ Dr. Dean Elterman (CA) stated that the burden of Benign prostatic hyperplasia (BPH) is significantly increasing. “In 2019, there were an estimated 94 million cases of BPH globally among men ≥ 40 years, this number is thought to have doubled in the last 20 years.”
According to Dr. Elterman, research has shown that only 50% of BPH drug patients are satisfied with the effectiveness of their medication, 48% to not have a clinically significant improvement in symptoms, SARI drugs take three to six months for symptom relief, and there are multiple side-effects that decrease quality of life.
He cited results from a paper by Sachin Malde et al., which found that men consistently preferred less invasive treatment options (non-surgical, local anaesthesia) with a low risk of adverse events, particularly those effecting sexual function. Up to 93% of men preferred a treatment with no sexual side effects.
Dr. Elterman outlined the four currently approved Minimally Invasive Surgical Treatments (MISTs - iTIND, Water Vapour Thermal Therapy – Rezum, TPLA, and Prostatic Urethral Lift/UroLift, with a visual comparison of IPSS (International Prostate Symptom Score) and Qmax (peakflow) over time. He also featured the soon to be approved Optilume BPH drug coated balloon. “Each MIST has unique attributes that demonstrate efficiency in BPO. Patient selection is key, as is understanding how each MIST differs to match the ideal treatment to the right patient. These options all offer men a less invasive experience which balances clinical improvement and the preservation of sexual function.”
Of note, he discussed his paper on the novel minimally invasive option First-line Interventional Treatments (FIT), which represents a paradigm shift in mLUTS treatment, potentially bridging the gap between pharmaceuticals and surgery with a balanced approach to efficacy, safety, and convenience. By enabling early intervention to preserve bladder health, enhance quality of life, and reduce the need for invasive treatments, FIT could become the preferred standard of care.
He concluded that not all patients will prioritise “BPO cure”, BPO management is more often the preference.
More information
You can watch the full webcast via the EAU25 Resource Centre, including a lecture by Prof. Thomas Herrmann (CH) on ‘Balancing the cost and efficacy of MISTs’ where he questions treatment availability of MISTs and the resulting inequalities.