The clinical and financial implications of a decade of prostate biopsies in the NHS: analysis of Hospital Episode Statistics (HES) data 2008-2019".

OBJECTIVE: To evaluate the clinical and financial implications of a decade of prostate biopsies in the United Kingdom National health Service (NHS) through the transrectal (TR) and transperineal (TP) route. In the current antibiotic resistant era, TR biopsies of the prostate have alarmingly high infectious complications and readmissions. The TP route is a credible step to minimise these events, however the data comparing the two approaches has not been consolidated. METHODS: This is an evaluation of TR versus TP biopsy approach in the context of 28 days post procedure complications and readmissions, with secondary evaluation of burden of expenditure in NHS hospitals over the entire decade (2008-2019) by evaluating national Hospital Episode Statistics (HES) data. RESULTS: In this data set of 486,467 prostate biopsies (387,879 TR and 98,588 TP), rates for infection and sepsis were higher for the TR compared to the TP cohort (0.53% vs 0.31% p <0.001 CI 99%). Rates of sepsis have more than doubled for TR biopsies in the last two years compared to the previous decade (1.12% Vs 0.53%). Infective complications were the main reasons for readmissions in the TR cohort; whereas urinary retention was the predominant reason for readmission in the TP cohort. Over the last decade, non-elective readmissions (NEL) seem higher for the TP group, however in the last two years these have reduced compared to the TR group (3.54% Vs 3.74%). The cost estimates for NEL re-admissions for the entire decade were pound33,589,527 and pound7,179,926 respectively for TR and TP cohorts (p < 0.001). Estimated costs per patient re-admission were pound2,225 and pound1,758 in the TR and TP groups (p < 0.001). CONCLUSIONS: Evaluation of nearly half a million prostate biopsies in the NHS over the entire decade gives sufficient evidence for the distinct advantages of the TP route over the TR route in terms of reduced infections and burden of expenditure. In addition there is a potential for saving both in upstream and downstream costs if performed under a local anaesthetic. Funding-Intuitive Surgical provided a research grant to access HES data via Harvey Walsh.