Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data

Andrew Morton; Michael Williams; Marlon Perera; Patrick E Teloken; Peter Donato; Sachinka Ranasinghe; Eric Chung; Damien Bolton; John Yaxley; Matthew J Roberts

doi:10.1111/bju.15098

Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data

BJU Int. 2020 Sep:126 Suppl 1:18-26. doi: 10.1111/bju.15098. Epub 2020 Jun 17.

Authors

Andrew Morton^{1

2}, Michael Williams^{1

2}, Marlon Perera^{1

2

3}, Patrick E Teloken^{1

2}, Peter Donato¹, Sachinka Ranasinghe^{1

2}, Eric Chung^{1

4

5}, Damien Bolton³, John Yaxley^{1

2}, Matthew J Roberts^{2

6

7}

Affiliations

¹ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
² Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
³ Department of Surgery, Austin Health, The University of Melbourne, Parkville, Victoria, Australia.
⁴ Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁵ Andro Urology Centre, Brisbane, Queensland, Australia.
⁶ Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia.
⁷ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia.

PMID: 32558340
DOI: 10.1111/bju.15098

Abstract

Objective: 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.

Patients and methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Medicare; benign prostatic hyperplasia; minimally invasive; national trends; surgical procedures; transurethral resection of prostate.

MeSH terms

Age Factors
Aged
Australia
Cystoscopy / statistics & numerical data
Drug Therapy, Combination
Dutasteride / therapeutic use
Health Care Costs
Hospitalization / statistics & numerical data
Humans
Lasers, Solid-State / therapeutic use
Longitudinal Studies
Male
Middle Aged
Minimally Invasive Surgical Procedures / statistics & numerical data
Procedures and Techniques Utilization
Prostatectomy / statistics & numerical data
Prostatic Hyperplasia / surgery
Prostatic Hyperplasia / therapy*
Radiofrequency Ablation / statistics & numerical data
Tamsulosin / therapeutic use
Transurethral Resection of Prostate / statistics & numerical data
Urological Agents / therapeutic use

Substances

Urological Agents
Tamsulosin
Dutasteride