143 TRENDS AND VARIATION IN MEDICAL MANAGEMENT OF MEN WITH BENIGN PROSTATIC HYPERPLASIA AND LOWER URINARY TRACT SYMPTOMS (1993-2010)

Abstract

INTRODUCTION AND OBJECTIVES: Management options for men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) have evolved over the last 15 years. We used a population-based survey to describe historical trends and variation in medical management of men with BPH/LUTS in the United States. METHODS: We used the National Ambulatory Medical Care Survey (1993-2010) to evaluate outpatient office visits by men with BPH/LUTS. Visits for BPH/LUTS were based on ICD-9 diagnosis codes for BPH and/or patient self-report of LUTS. Prescriptions of interest included -blockers (AB), 5reductase inhibitors (5ARI), and anticholinergics (AC). Standardized survey weights were applied to obtain national estimates. Data from multiple years were occasionally combined to ensure statistical reliability. Linear trends over time were analyzed using 2 tests. Factors associated with AB use were evaluated with 2 tests and multivariable logistic regression. All tests were performed to the 5% level of significance. RESULTS: From 1993-2010, there were over 141 million outpatient visits for men with BPH/LUTS. Among these visits, ABs were prescribed most commonly, increasing from 6.4% of visits in 1993 to nearly 30% in 2010 (p 0.01). Use of 5ARIs increased from 3.8% of visits in 1993-1994 to 14.3% of visits in 2009-2010 (p 0.01). Use of ACs also increased, from 2.3% of visits in 1999-2000 to 8.2% of visits in 2009-2010. Use of terazosin decreased from 78% of AB prescriptions from 1993-1995 to 12% from 2008-2010 (Figure). In the modern era, tamsulosin was the most common AB prescribed, representing 61% of prescriptions from 2008-2010 (Figure). Use of AB did not vary by race, region, or insurance status (all p 0.05). Compared to primary care physicians, urologists were no more likely to prescribe ABs prior to the introduction of tamsulosin (OR 0.88, 95% CI 0.57-1.35). However, after tamsulosin was available, urologists were nearly twice as likely to prescribe ABs (OR 1.92, 95% CI 1.41-2.62). CONCLUSIONS: Over the past 15 years, there has been a steady increase in use of medications to manage men with BPH. Urologists were more likely to prescribe ABs after tamsulosin was available, suggesting that urologists may adopt novel medications more readily that primary care providers. Source of Funding: NIH T32 Clinical Training Grant.