Initiation of nonselective alpha1-antagonist therapy and occurrence of hypotension-related adverse events among men with benign prostatic hyperplasia: a retrospective cohort study

Chrischilles, Elizabeth A.; Rubenstein, Linda M.; Chao, Jingdong; Kreder, Karl J.; Gilden, Daniel; Shah, Hemal

doi:10.1016/s0149-2918(01)80022-9

Cited by 42 publications

(59 citation statements)

References 15 publications

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“…Prazosin was not included because it generally is prescribed for twice-daily dosing and, in current practice, is rarely used to treat BPH. 17 Patients at initiation are defined as newly diagnosed (treatment naïve) or patients who have failed "watchful waiting" who have American Urological Association (AUA) symptom scores in the moderate range at baseline. After initiation of therapy, over the initial 6 months, the therapy is either successful or unsuccessful, where treatment success is defined as a 25% improvement in AUA symptom score from baseline.…”

Section: Ss Pharmacoeconomic Methods Model Structurementioning

confidence: 99%

“…Drug-induced hypotension also can have direct cost effects. Chrischilles and colleagues 17 found excess rates of resource utilization among new users of non-prostate-specific α 1 -blockers consistent with hypotensive episodes-often sprains and fractures associated with falls. The distribution of diagnosis codes in these cases was used to estimate the cost per excess fracture and nonfracture episode.…”

Section: Model Parametersmentioning

confidence: 99%

“…17 Using prescription drug and medical utilization claims data from a retiree health plan, Chrischilles and colleagues evaluated the incidence of hypotensive events among men aged 65 years or older with and without hypertension. Potential hypotensive events included syncope, postural hypotension, vertigo, fractures, and other injuries as indicated in the claims data.…”

Section: Ss Backgroundmentioning

confidence: 99%

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Cost-Effectiveness of Tamsulosin, Doxazosin, and Terazosin in the Treatment of Benign Prostatic Hyperplasia

Ohsfeldt

Kreder²,

Klein³

et al. 2004

JMCP

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enign prostatic hyperplasia (BPH) is a common and costly condition in the United States. Nearly 50% of men aged 50 years or older report symptoms of BPH, and prevalence increases with advancing age.1 As the U.S. population ages, the incidence of BPH will continue to grow. In addition to increasing incidence of BPH, patterns of treatment for BPH also are evolving, with movement from primarily surgical treatment (open prostatectomy and transurethral resection of the prostate [TURP] as well as newer, less invasive options) toward medical management of BPH symptoms. Surgery rates have decreased since alpha (α)-antagonists and 5α-reductase inhibitors became available to treat BPH. [2][3][4] Several pharmacoeconomic studies have evaluated the use of α-antagonists in the treatment of BPH. These analyses have demonstrated that α-antagonists have the potential to decrease costs relative to surgical interventions. 5,6 In addition, compared with placebo, α-antagonists have the ability to relieve symptoms without increasing overall health care costs by reducing costs for hospitalizations and outpatient visits. Overall cost-effectiveness for the different treatments may vary depending on individual patient characteristics and comorbid conditions.Pharmacoeconomic analyses of new treatment options for BPH are useful in view of the increased attention being placed on treatment costs and the increasing incidence of BPH. Because several established BPH treatments are available (each with a different mechanism of action, effectiveness rate, safety profile, and associated cost), consideration of cost-effectiveness analyses can help to quantify potential advantages of new treatment options to facilitate treatment choices.Tamsulosin (Flomax), an α 1A -selective antagonist, was approved by the U.S. Food and Drug Administration on April 15, 1997, for the medical management of BPH.7 Tamsulosin is prostate-specific and has reduced affinity for α-receptors in the peripheral vasculature. As such, tamsulosin has several characteristics that may lead to increased cost-effectiveness, including a favorable side-effect profile and less dosage titration compared with older generation nonselective α1-antagonists. Specifically, side effects of nonselective α1-antagonists, including orthostatic hypotension and syncope, can reduce patient adherence to medical therapy, thereby reducing effectiveness and increasing costs. The use of the α 1A -selective antagonist tamsulosin is associated with substantially lower rates of orthostatic symptoms than nonselective α 1 -antagonists. For example, Wilt et al. 8 report that 9.3% of patients treated with terazosin experienced orthostatic hypotension versus 1% in the control groups ABSTRACT OBJECTIVE: To evaluate the cost-effectiveness of tamsulosin, doxazosin, or terazosin as initial treatments for moderate benign prostatic hyperplasia (BPH) over a 3-year time horizon from a health-system-payer perspective.METHODS: A decision-analytic model is used to project the course of treatment at 6-month intervals o...

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Section: Ss Pharmacoeconomic Methods Model Structurementioning

confidence: 99%

Section: Model Parametersmentioning

confidence: 99%

Section: Ss Backgroundmentioning

confidence: 99%

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Cost-Effectiveness of Tamsulosin, Doxazosin, and Terazosin in the Treatment of Benign Prostatic Hyperplasia

Ohsfeldt

Kreder²,

Klein³

et al. 2004

JMCP

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show abstract

“…5,7,8 Researchers have reported an increase in the risk of hypotension-related adverse events, including hypotension, syncope and fractures, during the initiation period of α-blocker therapy. 9 Our research group found that the use of α-blockers was associated with an increased risk of hip and femur fractures during the early initiation period among older men without hypertension. 10 Whether the acute hypotensive effect of α-blockers can precipitate the episode of ischemic stroke has not been clarified in a large-scale study, although a case of acute hemiparesis after one dose of doxazosin has been reported.…”

mentioning

confidence: 89%

Risk of ischemic stroke during the initiation period of α-blocker therapy among older men

Lai

Kuo

Chen

et al. 2015

CMAJ

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“…They lower blood pressure and are associated with hypotension, dizziness and syncope, and an increased risk of falls, fractures and admission to hospital. [15][16][17][18] The risk appears to be greatest during the first eight weeks of treatment and then diminishes, but it persists during maintenance use 17,18 and recurs when restarting treatment. 18 A consensus panel concluded that tamsulosin offered questionable benefits in the treatment of older people with LUTS and that other alpha-blockers should be avoided, largely because of lack of evidence of efficacy in this age group and safety concerns.…”

Section: Alpha-blockersmentioning

confidence: 99%

Frailty and treatments for benign prostatic hyperplasia

Chaplin¹

2017

Prescriber

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Initiation of nonselective alpha1-antagonist therapy and occurrence of hypotension-related adverse events among men with benign prostatic hyperplasia: a retrospective cohort study

Cited by 42 publications

References 15 publications

Cost-Effectiveness of Tamsulosin, Doxazosin, and Terazosin in the Treatment of Benign Prostatic Hyperplasia

Cost-Effectiveness of Tamsulosin, Doxazosin, and Terazosin in the Treatment of Benign Prostatic Hyperplasia

Risk of ischemic stroke during the initiation period of α-blocker therapy among older men

Frailty and treatments for benign prostatic hyperplasia

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