Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population‐based data

Abstract

Objective To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. Patients and methods Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000–2018. Population‐adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. Results Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100 000 men) and dutasteride monotherapy (149 vs 336 per 100 000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100 000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100 000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezūm™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. Conclusion Despite reduced national BPH‐related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted.

Prescribing patterns for medical treatment of suspected prostatic obstruction: a longitudinal register-based study of the Scottish Health and Social Care Open Data

“…Greater understanding of these issues will facilitate planning to meet demand in primary care services given ongoing capacity shortage, and also secondary care as increased pharmacological treatment could be indicative of future demand for surgery. 23 Whether practices were NHS or GP-run, or had a dispensing pharmacy present within the GP practice, were associated with higher and lower prescribing volumes, respectively. While the individual characteristics of GP medical practices are known to differ by region 24 research accounting for these factors is relatively sparse; hence, it is unclear why this difference exists.…”

“…Fourth, we have not investigated how differences in GP prescribing practices for BOO may impact on the rates of surgical management of this condition. For example, a study in Australia identified regional differences in the surgical management of BOO secondary to BPH 23 ; it would be interesting for future research to potentially link BPH prescribing practice with rates of surgical management of this condition. For example, it might be the case that medical therapy can delay the need for surgery by a number of years, or reduced rates of BPH prescribing in any particular Health Board may be associated with higher rates of surgical intervention.…”

The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia

“…It is hoped that some of these novel devices will stand the test of time, in contrast to the vast majority of their predecessors. Recent population-based data from Australia indeed suggest a more profound and prolonged diffusion of novel minimal invasive procedures [39]. Yet, one has to be aware that there are relevant discrepancies on the use of minimally invasive treatments for LUTS/BPH in various healthcare systems (even in well-developed countries), mainly due to differences in the reimbursement system.…”

A National Analysis of Temporal Changes in Prescribing of Testosterone Replacement Therapy Considering Methods of Delivery and Government Regulation

“…Pharmaceutical Benefits Schedule Item Reports were queried in May 2019, similar to methodology described previously [ 19 20 21 ]. Annual prescription data from 1992 to 2018, as well as monthly data from April 2014 (one year prior to the PBS changes) to April 2019 were collected for the item numbers listed for TRT, shown in Table 1 .…”