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Title: Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data.
Austin Authors: Morton, Andrew;Williams, Michael;Perera, Marlon ;Teloken, Patrick E;Donato, Peter;Ranasinghe, Sachinka;Chung, Eric;Bolton, Damien M ;Yaxley, John;Roberts, Matthew J
Affiliation: Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Andro Urology Centre, Brisbane, Queensland, Australia
Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
Issue Date: Sep-2020 2020-06-17
Publication information: BJU International 2020; 126 (suppl 1): 18-26
Abstract: To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000-2018. Population-adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100 000 men) and dutasteride monotherapy (149 vs 336 per 100 000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100 000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100 000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezūm™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. Despite reduced national BPH-related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted.
DOI: 10.1111/bju.15098
ORCID: 0000-0001-9432-9509
Journal: BJU International
PubMed URL: 32558340
Type: Journal Article
Subjects: Medicare
benign prostatic hyperplasia
minimally invasive
national trends
surgical procedures
transurethral resection of prostate
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