Abstract
There has been a change in the focus of attention from prostate to bladder, as the etiology of lower urinary tract symptoms (LUTS) makes the bladder an additional therapeutic target. This study aims to evaluate the use of resources and costs associated with the addition of an antimuscarinic (AM) in patients receiving an alpha-adrenergic-blocker (AAB) for the treatment of LUTS linked to benign prostatic hyperplasia (BPH). A multicentre, retrospective study was conducted using patient records from the databases of six primary care centers in Spain. Men with moderate-to-severe LUTS (IPSS > 7) who were initiated on AM treatment between January 2010 and December 2012 without previous treatment with an AM or 5-alpha reductase inhibitor (5-ARI) and had been on treatment with an AAB for a minimum of 6 months prior to the addition of the AM with a minimum of two records in the database were included. Comorbidity, treatment persistence, and use of resources and costs (direct and indirect) during monotherapy (AAB alone) and following the introduction of combination therapy (AAB + AM) over a treatment period of up to a year were compared. A paired sample Student t-test was performed where p < 0.05 were considered significant. One hundred and ninety-one patients (mean age (SD): 70 (10.4) years) were treated with combination therapy. Treatment persistence on combination therapy after 12 months was 65.4% (95% CI: 58.8-72.2%). Use of resources was numerically lower after initiation of combination therapy vs pre-treatment (AAB alone) period for medical visits (/year/patient) (13.4 (4.6) vs 15.4 (4.4) p < 0.010), percentage of patients using concomitant medication (13.3% vs 19.1%) and use of pads (9.7% vs 13.4%) among others analyzed. Comparing AAB vs AAB + AM, there were a numeric reduction in total cost/year (€2399 vs €2011; p = 0.135) and a reduction of costs due to medical visits (€645 vs. €546; p = 0.003) and concomitant medication (€181 vs. €101; p = 0.009). The addition of an AM agent in patients treated for LUTS with AAB is associated with a lower use of healthcare resources in terms of number of medical visits, and concomitant medications required, thereby leading to reduction of overall costs to the healthcare system.
Highlights
There has been a change in the focus of attention from prostate to bladder, as the etiology of lower urinary tract symptoms (LUTS) makes the bladder an additional therapeutic target
Drug treatment is indicated in patients with moderate-to-severe symptoms who do not present an absolute indication for surgery [13], and the combination of an antimuscarinic with an alpha-blocker is justified in patients with benign prostatic hyperplasia (BPH) and LUTS compatible with co-existing overactive bladder [7, 9, 10, 13, 14]
Inclusion and exclusion criteria All male patients suffering from LUTS who started addon therapy with an AM between January 2010 and December 2012 were included in the study if they fulfilled the following criteria: a) aged ≥45 years; b) assigned to the geographical reference area; c) no previous treatment with AM or 5-alpha reductase inhibitor (5-ARI); d) current treatment with an AAB; e) moderate-to-severe LUTS (IPSS > 7); f ) regular follow-up was likely, and g) on a chronic treatment prescription program with a proven record of the daily dose, timeframe and the duration in each administered treatment
Summary
There has been a change in the focus of attention from prostate to bladder, as the etiology of lower urinary tract symptoms (LUTS) makes the bladder an additional therapeutic target. The insufficient response in alleviating LUTS related to BPH in some cases, together with the increasing recognition of the complexity of the pathophysiology of the lower urinary tract as a functional unit, has helped to shift the focus of attention from the prostate to the bladder as a possible cause of LUTS, making it an additional therapeutic target [8,9,10] This change of perspective, acknowledging the multifactorial etiology of male LUTS, and accepting that not all of the symptoms are necessarily related to the prostate, is mirrored in the current guidelines of Scientific Societies [1, 3, 5,6,7]. There is limited data on the impact these treatments have on resource utilization and costs
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