National Institute for Health and Clinical Excellence (NICE)
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NICE consults on plans to support new device for treating enlarged prostate glands
NICE is asking for views on its plans to support using a device for treating enlarged prostate glands – benign prostatic hyperplasia – in a consultation opening today (Tuesday 26 January).
The draft medical technology guidance provisionally recommends the use of the GreenLight XPS 180 W laser system in non-high-risk patients, which means men who don’t have an increased risk of bleeding, whose prostates are smaller than 100 ml and who don’t have urinary retention.
Prostate enlargement is a common condition in older men – around 60% of men aged 60 or over have the condition. An enlarged prostate can push against the urethra, making it difficult for a man to pass urine. It may also lead to repeated urinary tract infections, urinary retention and sleep problems due to the urge to urinate in the night, but the condition doesn’t pose other direct risks to health.
The device, GreenLight XPS 180 W, involves using a laser to vaporise excess prostate tissue, so easing the blocked urethra and leaving a clear channel for urine to flow. The claimed benefits of the system include a quicker return to normal activity following treatment, shorter hospital stay because the procedure can be done as a day-case, and reduction in pain leading to improved quality of life.
The draft guidance notes that there’s currently not enough evidence to support the use of the device in high-risk patients so recommends data collection. It also proposes that where GreenLight XPS 180 W is used, urology services should be redesigned to ensure that facilities for day-case surgery are available. An estimated saving of up £60 per patient could be made using this device when compared with the procedure transurethral resection of the prostate (TURP).
Professor Carole Longson MBE, Director of the NICE Centre for Health Technology Evaluation, said: “This draft guidance on GreenLight XPS 180 W provisionally supports the use of this device for men with an enlarged prostate who don’t have high risk factors including increased risk of bleeding. The evidence examined by the independent Medical Technologies Advisory Committee indicates that using the device may benefit patients by needing a shorter hospital stay and quicker return to normal activities, and is also likely to benefit the NHS by saving money. There isn’t enough high quality evidence to make provisional recommendations on GreenLight’s use in treating enlarged prostates in men classed as high risk, so we propose that specialists collaborate to collect and publish data for these patients to improve the evidence base. We welcome comments on the draft guidance as part of this consultation.”
More information on the medical technology draft guidance consultation for GreenLight XPS 180 W is available at http://www.nice.org.uk. The consultation closes on 23 Feb 2016.
For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142, or out of hours on 07775 583 813.
Notes to Editors
About the NICE guidance
- The draft medical technology guidance, “GreenLight XPS 180 W for treating benign prostatic hyperplasia”, is available athttp://www.nice.org.uk/guidance/indevelopment/gid-mt265 from Tuesday 26 January.
- The GreenLight XPS 180 W is manufactured by Boston Scientific.
- The cost of the device: the company submission stated that the GreenLight XPS 180 W laser console is usually provided at no cost to the NHS, as part of a contractual arrangement with the company to purchase a minimum number of laser fibres over a specified time period at an average price of £550 per fibre (excluding VAT).
- Cost modelling estimates that cost savings with Greenlight XPS 180 W compared with TURP (transurethral resection of the prostate, where prostate tissue is cut away) are determined by the rate of day-case treatment. With a day-case rate of 36%, estimated cost savings are £60 per patient. Expert advice indicates that higher day-case rates than this, and therefore greater cost savings, are plausible. National total cost-savings (assuming a day-case rate of 36%) across all NHS providers may be around £800,000 per year.
- NICE issued guidance supporting the use of the UroLift system (inserting prostatic urethral lift implants): “UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia”, in September 2015, available athttp://www.nice.org.uk/guidance/mtg26.
- NICE issued guidance supporting the use of the TURis system for transurethral resection of the prostate (a bipolar electrosurgery system to cut away or vaporise excess prostate tissue) in February 2015:http://www.nice.org.uk/guidance/mtg23.
About the Medical Technologies Evaluation Programme
- The Medical Technologies Evaluation Programme focuses specifically on the evaluation of innovative medical technologies, including devices and diagnostics. The types of products which might be included are medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions. The independent Medical Technology Advisory Committee has two core remits: selecting medical technologies for evaluation by NICE guidance programmes and also developing medical technologies guidance itself. The guidance applies to the NHS in England, and is not mandatory.
More information is available at http://www.nice.org.uk/MT.
About NICE
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.
Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.
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