Medical Consumption and Costs during a One-Year Follow-up of Patients with LUTS Suggestive of BPH in Six European Countries: Report of the TRIUMPH Study

Abstract

Objective

To determine the medical consumption and associated treatment costs of patients with LUTS suggestive of BPH.

Methods

A prospective, cross-sectional, observational survey in six European countries: France, Germany, Italy, Poland, Spain and the United Kingdom, with a one-year follow-up of incident and prevalent patients.

Results

Treatment costs were estimated for 5,057 patients with a mean age of 66 years and a mean IPSS score at inclusion of 11.5. In 30% of patients watchful waiting was the therapy of choice for the full follow-up period, 57% were prescribed alpha-lockers, 11% finasteride and 10% phytotherapy at any moment during the follow-up (including switches and combination of treatment). Surgery rate was 4.9%. Mean one-year treatment costs were €858 per patient, three quarters of which concerned medication costs. Multivariate regression analysis showed that medication choice, complications and undergoing surgery were associated with higher costs.

Conclusions

Treatment costs for patients with LUTS suggestive of BPH were moderate and largely consisted of medication costs. Daily practice and associated costs varied considerably across the six countries.

Introduction

Low Urinary Tract Symptoms(LUTS) suggestive of Benign Prostatic Hyperplasia(BPH) are a common condition in ageing men. It occurs in 25% of men aged 40 years and over and its prevalence increases with age from 3.5% to 35% for men in their late 40s and 80s respectively [1], [2], [3], [4], [5]. Recently, it was shown that the incidence rate of LUTS suggestive of BPH is 15 per 1,000 man-years, increasing linearly from three cases per 1,000 man-years at the age 45–49 years to 38 cases per 1,000 man-years at the age of 75–79 years, remaining constant after the age of 80. Corresponding prevalence rates were 2.7% for males aged 45–49 years to 24% at the age of 80 years [6]. Given the ageing of the population, the number of patients with LUTS suggestive of BPH may be expected to increase substantially [7]. Moreover, as these patients will live longer while expecting a maintained quality of life, the total cost of treatment is expected to increase dramatically [1]. For instance, treatment costs in the Netherlands are expected to be more than double the present level by the year 2035 [8]. Because costs may be expected to increase throughout health care and resources to become increasingly scarce, information regarding the costs and cost-effectiveness of treatment policies is pivotal for future rational management of LUTS suggestive of BPH.

There is a great deal of scientific information available on the efficacy and tolerability of treatment options for LUTS suggestive of BPH [9], [10], [11], [12]. The availability of recent and reliable information regarding treatment policies applied in patients suffering from LUTS suggestive of BPH, the corresponding medical consumption, and the associated treatment costs (let alone cost-effectiveness) is however very limited [1], [13]. Thus far, health-economic studies mainly concentrated on cost comparisons and cost-effectiveness analyses of individual surgical interventions, such as Open Prostatectomy, Transurethral Resection of the Prostate(TURP), Transurethral Microwave Chemotherapy(TUMT) and laser therapy [14], [15], [16], [17]. A recent overview of treatment patterns and costs for European countries, including the alleged increasing significance of medication costs, is limited to broad estimates [18], [19].

For this reason, the Trans European Research into the use of Management Policies for BPH in Primary Healthcare(TRIUMPH) project was set up in 1999. Its objective was to describe currently applied treatment policies for LUTS suggestive of BPH and their consequences for disease progression, related quality of life and costs in six European countries: France, Germany, Italy, Poland, Spain and the United Kingdom [1]. In this paper we present the results of the multi-country costs study, i.e., the medical consumption related to LUTS suggestive of BPH and the associated treatment costs as observed during a one-year follow-up period. Treatment costs will be compared among the six countries that participated in the study and will be related to characteristics of patients, severity of illness and treatment policies. Finally, multivariate regression analysis will be applied to investigate the main determinants of treatment costs related to LUTS suggestive of BPH. The costs study is part of the health-economic analysis in the TRIUMPH study [13].