Benign Prostatic Hyperplasia: Counting the Cost of Its Management

Abstract

9 0 1 INTRODUCTION BPH is estimated to affect around 3.2 million men of middle age and beyond in the UK. BPH not only has a serious effect on the quality of life of patients and their families; the condition is also expensive for the NHS, both in terms of costs both for GP practices in primary care, and for urology services in secondary care. Moreover, BPH, especially if acute urinary retention (AUR) develops, can have a very deleterious effect on an individual's quality of life [1]. In the future the social and economic burden is only likely to increase with the rising numbers of men with bothersome LUTS resulting from the increasing prevalence of BPH in the ageing population. From Hospital Episode Statistics (HES) data [2](2007/2008) urology currently represents the fifth most expensive disease area for the UK NHS, accounting for an expenditure of £1.16 billion each year. Surgery for BPH represents the 10th most common operation across the NHS, and AUR is amongst the top 5% of causes of acute admissions to NHS hospitals.Although there are published estimates for the number of men affected by BPH symptoms in the UK, accurate, up-to-date data on the number of men who visit their GP to discuss these symptoms are limited to local, practice-based surveys. The latest published national data are from the Third National Morbidity Survey (1983) which reported that 0.51% of all GP consultations were for BPH. If we adopt the assumption that the proportion of consultations for BPH has remained the same (0.51%), we can combine these data with current all-cause consultation rates and population data to estimate the average number and cost of primary-care consultations related to BPH each year. Using an all-cause consultation rate of 5. Using HES data for 2007/2008, which are based on all hospital treatments in England, an estimate of the volume of hospital treatment for BPH can be made for the UK as a whole. HES data for England show that 28 499 men were admitted to hospital with AUR at a total tariff cost of £29 702 780, and 26 618 were admitted to hospital for BPHrelated surgery (e.g. TURP) at a cost of £55 357 650. Adding these costs together and applying an increase factor of 19% to reflect the whole UK population gives a total cost for treating these major complications of BPH in secondary care of £101 221 912.It seems reasonable to assume that additional costs are incurred as a result of patients requiring review in the urology clinic, either before their admission for surgery or after their discharge from either elective surgery or procedures related to AUR. It is standard practice and therefore assumed that all patients admitted for BPH-related surgery will have a preoperative consultation at a tariff of £161, followed by one postoperative followup at a tariff of £80. Similarly, it is assumed that all men admitted with AUR have a follow-up review at a tariff of £80. This equates to an additional cost of £10 346 881 directly attributable to the costs of treating key BPH complications in the UK.Using these costs, base...

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