The economics of medical therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia

Abstract

Medical therapy is currently the most popular treatment choice for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Because medical therapy of BPH-related LUTS is considered a life-long strategy, short-and long-term cost considerations should play a major role in therapeutic decision-making. The effectiveness in terms of long and short amelioration of symptoms, flow rate, and quality of life are well documented for 5α-blockers and 5α-reductase inhibitors as well as for the gold standard treatment for BPH, transurethral resection of the prostate and minimally invasive therapies. Short-and long-term safety concerns also are well documented for these various treatment options. On the contrary, short-and long-term costs have been less well studied and comparisons depend on the model or analyses undertaken in the few studies available. However, the economic studies based on prospective clinical trial data that have become available throughout the past several decades allow us to rationalize our use of α-blockers, 5α-reductase inhibitors, and combination therapy, taking into consideration age, severity of symptoms, prostate volume, prostate-specific antigen, and the differential response of the various medications (and combination) in selected patients. Based on current studies, 5α-blockers generally provide cost-effective therapy for most patients, whereas 5α-reductase therapy and combination therapy provide cost-effective treatment for patients with larger prostate glands or higher baseline prostate-specific antigen levels.

A genetic variant nearGATA3implicated in inherited susceptibility and etiology of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS)

“…One third of men with BPH ultimately undergo medical and/or surgical interventions. In addition, BPH has been associated with increased risks of mortality, depression, and diminished health‐related quality of life, as well as with billions of U.S. dollars in annual health expenditures . These societal and financial burdens are becoming exacerbated with the shift towards an older age distribution of the population in economically developed countries.…”

Cost of illness of medically treated benign prostatic hyperplasia in Hungary

“…IPSS total severity score, formed based on the first seven questions, ranges between 0 and 35, where higher score corresponds to greater severity. Based on IPSS total scores, patients were categorised into mild (IPSS 0-7), moderate (IPSS [8][9][10][11][12][13][14][15][16][17][18][19] and severe (IPSS 20-35) groups. Besides IPSS, urologists scored their patients' severity on a 10-point VAS.…”

“…On a 3-to 5-year time horizon, it proved to be cost-effective compared to either placebo, or surgery, or minimally invasive treatments [8]. Owing to the TRIUMPH survey (Trans European Research into the use of Management Policies for LUTS suggestive of BPH), treatment costs for patients with BPH are available for six European countries including France, Germany, Italy, Poland, Spain and the UK [9].…”