NDLI: Clinical progression, acute urinary retention, prostate-related surgeries, and costs in patients with benign prostatic hyperplasia taking early versus delayed combination 5 -reductase inhibitor therapy and -blocker therapy: a retrospective analysis.

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Clinical progression, acute urinary retention, prostate-related surgeries, and costs in patients with benign prostatic hyperplasia taking early versus delayed combination 5 -reductase inhibitor therapy and -blocker therapy: a retrospective analysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Morlock, Robert Goodwin, Bridgett Gomez Rey, Gabriel Eaddy, Michael
Spatial Coverage	United States
Description	Country affiliation: United States Author Affiliation: Morlock R ( Henry Ford Hospital, Detroit, MI, USA. rmorlock@yourcarechoice.com)
Abstract	BACKGROUND: Two previous retrospective database analyses compared early combination therapy with an -blocker (AB) and 5- reductase inhibitor (5-ARI) to delayed combination therapy and found that patients receiving the delayed combination therapy were more likely to have clinical progression, acute urinary retention (AUR), and surgery. Although these studies indicate the clinical benefits of early treatment, both studies failed to take into account important baseline clinical measures, such as prostate-specific antigen (PSA) values. OBJECTIVE: This study was designed to compare clinical and cost differences in men with benign prostatic hyperplasia (BPH) who initiated early versus delayed combination therapy with a 5-ARI + an AB, factoring in baseline PSA values. METHODS: This retrospective claims data analysis assessed data from >14 million US men with linked medical data, pharmacy data, laboratory results, and enrollment information from January 1, 2000, to December 31, 2009. Men aged 50 or older and treated for BPH with a 5-ARI + an AB were identified. Patients were required to be eligible for services at least 6 months before and 12 months after the index medication date. Patients were assigned to 1 of 2 treatment groups based on therapy (early or delayed) and 3 cohorts based on availability of PSA laboratory values (patients with a PSA value, patients with a PSA value >1.5 and <10, and all patients). Using a logistic model, the likelihood of clinical progression (defined as the occurrence of AUR or prostate surgery) during the 12 months after the date of first prescription fill was compared between BPH patients receiving early versus delayed combination therapy. BPH-related medical costs (excluding pharmacy costs) were assessed using generalized linear models. RESULTS: Among the 13,551 patients identified for study inclusion, the highest risks for clinical progression, AUR, and prostate-related surgery were consistently demonstrated in patients with a PSA >1.5 and <10. Across all 3 cohorts, the delayed combination-treatment group was more likely to have clinical progression, AUR, and prostate-related surgeries versus the early combination-treatment group. The incremental difference in BPH-related costs between the delayed and early combination-treatment groups was \$190 per patient overall; the greatest incremental difference (\$397) was observed in patients with PSA >1.5 and <10. CONCLUSIONS: The results suggest that early initiation of combination therapy with 5-ARI + an AB, compared with delayed initiation, can reduce the risks for clinical progression, AUR, and prostate-related surgeries, as well as BPH-related medical costs, in patients with BPH.
File Format	HTM / HTML
ISSN	01492918
Issue Number	5
Volume Number	35
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2013-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology 5-alpha Reductase Inhibitors Therapeutic Use Adrenergic Alpha-antagonists Prostatic Hyperplasia Drug Therapy Urinary Retention Administration & Dosage Aged Disease Progression Drug Therapy, Combination Health Care Costs Humans Likelihood Functions Linear Models Logistic Models Male Middle Aged Prostate-specific Antigen Blood Pathology Surgery Retrospective Studies Time Factors United States Etiology Comparative Study Journal Article
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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