The economics of benign prostatic hyperplasia treatment: a literature review

Kortt, Michael A.; Bootman, J. Lyle

doi:10.1016/s0149-2918(96)80078-6

Cited by 41 publications

(20 citation statements)

References 20 publications

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“…1 The enlarging gland results in significant urinary obstruction and frequently requires surgical and/or medical intervention to restore urinary health. It is estimated that BPH has an annual cost of $4 billion per year in the US.…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that BPH has an annual cost of $4 billion per year in the US. 1 BPH is characterized by an increase in both epithelial and stromal components of the prostate and has a heterogeneous morphology with-mixture of hyperplastic, atrophic and dilated glands and increased stromal smooth muscle and collagen. Chronic inflammatory changes with a variable lymphocytic infiltrate are frequently observed.…”

Section: Introductionmentioning

confidence: 99%

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Abnormalities of apoptotic and cell cycle regulatory proteins in distinct histopathologic components of benign prostatic hyperplasia

Gandour‐Edwards

Mack

DeVere-White

et al. 2004

Prostate Cancer Prostatic Dis

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Introduction: Benign prostatic hyperplasia (BPH) is a slowly progressive abnormal glandular enlargement with heterogeneous morphology. Disruption of apoptotic pathways has been suggested as an important regulatory mechanism in this common and significantly morbid disease. Methods: Prostatic tissue from 20 patients with BPH and no prior or subsequent prostatic carcinoma was obtained by transurethral prostatectomy (TURP) at the University of California Davis. Apoptotic regulatory proteins: BCL2, BAX and p27 were analyzed by immunohistochemistry and evaluated for expression in four distinct histologic patterns: hyperplastic epithelium, nodules, dilated glands and atrophic/inflammatory glands. Results: Particularly striking was the decreased expression of BAX and an abnormal BCL2 : BAX ratio within all nodules relative to expression in other epithelial patterns. p27 expression was decreased in 35% of the hyperplastic epithelial areas and 10% of the nodules. Discussion: Overall, abnormal expression of BCL2, BAX and/or p27 was identified in the hyperplastic epithelium of 19 (90%) of specimens and all 12 (100%) of the hyperplastic nodules. The high frequency of abnormalities in apoptosis regulatory genes, suggests that alteration of apoptotic pathways is important for the development of this condition.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Abnormalities of apoptotic and cell cycle regulatory proteins in distinct histopathologic components of benign prostatic hyperplasia

Gandour‐Edwards

Mack

DeVere-White

et al. 2004

Prostate Cancer Prostatic Dis

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“…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.…”

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confidence: 99%

“…Most of these have been summarized in several literature review papers. 5,6,11 Although none of these published analyses evaluate the costeffectiveness of tamsulosin as a treatment strategy for BPH, highlighting the findings in some of these prior studies provides context for the present study.One of the first attempts to quantify short-term comparative costs of standard surgical interventions and medical therapies for BPH was published in 1994 by the Agency for Health Care Policy and Research (AHCPR) as part of the final report for the Prostate Patient Outcomes Research Team (Prostate PORT) project. 12 The model compared total costs for 2 years of treatment for each of the following initial therapies: watchful waiting, drug therapy (finasteride or α-blocker), balloon dilation, TURP, and open prostatectomy.…”

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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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The expression of androgen‐responsive genes is Up‐Regulated in the epithelia of benign prostatic hyperplasia

O’Malley¹,

Dhir

Nelson

et al. 2009

The Prostate

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BACKGROUND-Benign prostatic hyperplasia (BPH) is one of the most common diseases among aging men in the United States. In addition to aging, the presence of androgens is another major risk factor in BPH development. However, whether androgen signaling is altered in BPH remains unclear. To determine androgen signaling in BPH, we characterized the expression of 4 different androgenresponsive genes, Eaf2/U19, ELL2, FKBP5, and PSA, in BPH and adjacent normal glandular epithelial cells.

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The economics of benign prostatic hyperplasia treatment: a literature review

Cited by 41 publications

References 20 publications

Abnormalities of apoptotic and cell cycle regulatory proteins in distinct histopathologic components of benign prostatic hyperplasia

Abnormalities of apoptotic and cell cycle regulatory proteins in distinct histopathologic components of benign prostatic hyperplasia

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

The expression of androgen‐responsive genes is Up‐Regulated in the epithelia of benign prostatic hyperplasia

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