To analyze actual long-term medical treatment of benign prostatic hyperplasia (BPH) and compare the incurred cost with that of BPH patient who underwent immediate surgery.
Patients who were first diagnosed with BPH from January 1, 2008 to December 31, 2010 were identified using the Clinical Data Warehouse. Hospital billing data generated by the electronic hospital management system were collected till December 2015. For the outpatient care, only procedures, materials and drugs directly related to the management of BPH were selected for the analysis. For the inpatient care, all procedures, materials and drugs ordered on dates with continuity with BPH surgery date were included. The primary endpoint of the study was the total treatment-related direct costs of patients undergoing a long-term curative medical therapy for BPH (group 1), which was arbitrarily defined as any medical therapy including a 5 alpha-reductase inhibitor with minimum medication possession ratio of 0.5 during 5 consecutive years and more, or at least one year until BPH surgery due to medical therapy failure. Seventy patients who underwent BPH surgery within 1 year of initial visit were served as control (group 2).
Among one hundred thirty-seven patients in the group 1, 4 patients underwent BPH surgery at a median of 57.8 months after the initial visit (2.9%). At a median follow-up of 76 months, the mean total treatment cost was significantly higher in the group 1 than in the group 2 ($3,987 vs $3,036, p<0.001). Similarly, the mean out-of-pocket was significantly higher in the group 1 than in the group 2 ($1,742 vs $1,436, p=0.005). When a linear increment of annual BPH treatment cost is assumed for the group 1 and all costs are assumed to be produced within the first year for the group 2, the total and the out-of-pocket costs became equal at the end of the 5th year of the medical treatment. For both total and out-of-pocket costs, medication-related costs occupied the largest proportion exceeding the half of the costs.
We suggest patient counseling at the beginning of BPH treatment should include the likelihood that the cumulative out-of-pocket cost at 5 years of continuous medication will exceed that of immediate surgery. Our cost study using hospital billing data extractable from the electronic hospital management system may be a good model for cost studies that could provide valuable information to health providers and payers. This article is protected by copyright. All rights reserved.
BJU international. 2018 Oct 10 [Epub ahead of print]
Hyun Soo Ahn, Se Joong Kim, Jong Bo Choi, Seol Ho Choo, Kang Hee Shim, Sun Il Kim
Department of Urology, Ajou University School of Medicine, Suwon, South Korea.