PUK4 - The Budget Impact of Treatment Pathway Redesign In Men With Lower Urinary Tract Symptoms (Luts) Associated With Benign Prostatic Hyperplasia (Bph)

Abstract

LUTS associated with BPH (LUTS/BPH) in men may present as a combination of voiding, storage and post-micturition symptoms. UK prescribers have proposed two areas of improvement to current care: first, acknowledging that α-blocker monotherapy may not address bothersome storage symptoms; and second, building confidence in primary care to prescribe drug combinations for mixed symptoms. We built a model to evaluate the potential budget savings from implementing these treatment pathway changes. A model was built in Microsoft® Excel to depict a simplified LUTS care pathway, aligned with current clinical practice and NICE treatment recommendations in a hypothetical cohort of 10,000 men with LUTS/BPH who have moderate-to-severe storage and voiding symptoms. The budget impact of a proposed pathway redesign was calculated, which could adjust the number of men diagnosed and managed in primary care. Men could receive a range of treatment options, and if symptoms persisted, could ultimately be recommended for surgery. The model estimated several annual cost savings: –£2,964,169 by increasing the proportion of men diagnosed in primary rather than secondary care from 30% to 40%; –£1,623,701 by increasing the proportion of men receiving initial LUTS treatment in primary rather than secondary care from 50% to 60%; and –£4,114,738 by increasing the proportion of men receiving combination rather than monotherapy from 6% to 20%. A combination of all proposed changes resulted in a saving of –£8,208,061. Varying drug choice or cost were shown to have minimal financial impact. The pathway redesign indicates substantial savings. Specifically, increasing primary care diagnosis and treatment of LUTS/BPH symptoms would avoid referral costs and potentially delay surgery, while increasing general practitioner confidence in prescribing multiple drug classes may improve care for men with substantial storage symptoms that have not been adequately addressed by α-blocker monotherapy.