BPHMedical 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☆
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].
Section snippets
Study design
A prospective, cross-sectional, observational (i.e., non-interventional) survey was conducted in six European countries: France, Germany, Italy, Poland, Spain and the United Kingdom. Patients with LUTS suggestive of BPH (prevalent and incident) were enrolled and prospectively followed for at least one year. In accordance with international guidelines, indication for LUTS treatment was defined as symptomatic and/or bothersome LUTS, mostly expressed in AUA/IPSS score above seven. In daily
Population
Patients were recruited between February 2000 and June 2002; data collection closed May 2003. The total patient sample comprised of 5,057 patients (Table 1). On average patients were about 66 years old in any country. The overall average IPSS score at inclusion was 11.5, ranging from 10.3 in France to 13.3 in the United Kingdom.
Medical consumption
About 40% of patients visited a GP and 67% consulted a urologist during the one-year follow-up (see Table 2). The visitors paid on average 2.2 visits to their physician.
Discussion
Many elderly men suffer from LUTS suggestive of BPH. The number of patients and the associated treatment costs are expected to increase dramatically, unlike available health care budgets. For rational management of LUTS suggestive of BPH in the future, reliable information regarding the costs and cost-effectiveness of treatment policies is pivotal. Thus far, however, health economic studies of treatment policies for LUTS suggestive of BPH mainly concentrated on cost comparisons and
Acknowledgement
This research effort was financed by an unrestricted grant from Yamanouchi Europe. We thank Richard Farmer and Annie Hutchinson of the University of Surrey for preparing the database, and our colleagues Jan van Busschbach and Herman Stoevelaar for their contributions in an earlier phase of the project. We thank four anonymous reviewers for their comments.
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TRIUMPH: Trans European Research into the use of Management Policies for LUTS suggestive of BPH in Primary Healthcare.
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See Appendix A.