scholarly journals High regional variation in prostate surgery for benign prostatic hyperplasia in Switzerland

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254143
Author(s):  
Maria M. Wertli ◽  
Brigitta Zumbrunn ◽  
Pascal Weber ◽  
Alan G. Haynes ◽  
Radoslaw Panczak ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Socioeconomic Factors ◽  
Regional Variation ◽  
Disease Burden ◽  
Treatment Options ◽  
Population Based ◽  
Prostatic Hyperplasia ◽  
Multilevel Regression ◽  
Discharge Data ◽  
Swiss German

Background Among various treatment options for benign prostatic hyperplasia (BPH), surgical therapy is the most invasive. As Switzerland has the highest transurethral prostatectomy rate among OECD countries, we assessed the regional variation in prostate surgery for BPH and explored potential determinants of variation. Methods We conducted a population-based analysis using discharge data for men aged ≥40 years with transurethral or simple prostatectomy from all Swiss hospitals during 2013–2018. After excluding patients with genitourinary/prostate cancer, we derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). We estimated the reduction in variance across HSAs of prostatectomy rates in multilevel regression models, with incremental adjustment for age, regional cultural and socioeconomic factors, disease burden, density of urologists, and the time since urologists’ graduation. Results Overall, 44,253 prostatectomies (42,710 transurethral and 1543 simple) from 44 HSAs were analyzed. The mean age-standardized prostate surgery rate was 314 (range 166–500) per 100,000 men aged ≥40 years per year. The EQ was 3.01 and the SCV 5.53, indicating a high regional variation. In multivariate models, men aged 75–79 years had an 11.6-fold higher prostatectomy rate than those aged 50–54 years. French/Italian language areas had a 21% lower rate than Swiss German speaking areas. Socioeconomic factors, disease burden, and density of urologist/time since graduation were not associated with prostatectomy rates. After full adjustment, 80% of the variance in prostate surgery across HSAs remained unexplained. Conclusion We found a remarkably high regional variation in prostate surgery rates for BPH within Switzerland.

scholarly journals Metformin use and long-term risk of benign prostatic hyperplasia: a population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041875
Author(s):  
Mette Nørgaard ◽  
Bianka Darvalics ◽  
Reimar Wernich Thomsen
Keyword(s):  
Cohort Study ◽  
Benign Prostatic Hyperplasia ◽  
Cox Regression ◽  
Population Based ◽  
Prostatic Hyperplasia ◽  
Haemoglobin A1c ◽  
First Line ◽  
Intention To Treat ◽  
Lowering Drug

ObjectiveTo assess whether metformin use affects risk of benign prostatic hyperplasia (BPH) by comparing the risk of BPH in men with type 2 diabetes who initiated first-line treatment with either metformin or sulfonylurea monotherapy between 2000 or 2006 in Northern Denmark. In this period, sulfonylurea and metformin were both frequently used as first-line glucose-lowering drug (GLD) treatment.DesignA population-based cohort study.SettingNorthern Denmark.ParticipantsAll men who filled at least two prescriptions for metformin or for sulfonylurea, respectively, during their first 6 months of GLD treatment. Follow-up started 6 months after treatment start.Primary outcome measuresRates of subsequent BPH, identified based on community prescriptions for BPH-related treatment or hospital BPH diagnoses, and rates of transurethral resection of the prostate (TURP). Rates in metformin and sulfonylurea users were compared overall and stratified by 6-month haemoglobin A1c (HbA1c) using Cox regression and an intention-to-treat (ITT) approach and an as-treated analysis.ResultsDuring follow-up, less than five persons were lost to follow-up due to emigration. In 3953 metformin initiators with a median follow-up of 10 years, the 10-year cumulative BPH incidence was 25.7% (95% CI 24.2 to 27.1). Compared with 5958 sulfonylurea users (median follow-up 8 years, 10-year cumulative incidence 27.4% (95% CI 26.2 to 28.6)), the crude HR for BPH was 0.83 (95% CI 0.77 to 0.89) and adjusted HR in the ITT analyses was 0.97 (95% CI 0.88 to 1.06). For TURP, the adjusted HR was 0.96 (95% CI 0.63 to 1.46). In the as-treated analysis, adjusted HR for BPH was 0.91 (95% CI 0.81 to 1.02).ConclusionsCompared with sulfonylurea, metformin did not substantially reduce the incidence of BPH in men with diabetes.

scholarly journals 1974 POPULATION BASED TRENDS IN THE SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Florian R. Schroeck ◽  
John M. Hollingsworth ◽  
Samuel R. Kaufman ◽  
Rodney L. Dunn ◽  
Brent K. Hollenbeck ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Population Based ◽  
Prostatic Hyperplasia

scholarly journals Cardiovascular Safety and Possible Benefit of a 5-Alpha Reductase Inhibitor among Benign Prostatic Hyperplasia Patients, A Nationally Representative Cohort of Korean Men

2019 ◽  
Vol 8 (5) ◽  
pp. 733
Author(s):  
Jooyoung Chang ◽  
Seulggie Choi ◽  
Kyuwoong Kim ◽  
Sang Min Park
Keyword(s):  
Cardiovascular Disease ◽  
Benign Prostatic Hyperplasia ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Prostatic Hyperplasia ◽  
Cumulative Exposure ◽  
Primary Study ◽  
Unexpected Finding ◽  
Nationally Representative

Several studies suggest that 5-alpha reductase inhibitors (5ARIs) may be associated with elevated risk of cardiovascular disease (CVD). We investigated the association of 5ARI exposure and CVD incidence using the National Health Insurance Service-Health Screening Cohort, a nationally representative population-based sample of Koreans. We calculated the 4-year cumulative exposure to 5ARI for 215,003 men without prior 5ARI use. Participants were followed from January 1st, 2008 to December 31st, 2015. A subcohort of newly diagnosed benign prostatic hyperplasia (BPH) patients during 2004–2010 was also analyzed. The primary study outcome was CVD and secondary outcomes were myocardial infarction (MI) or stroke. Hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for conventional risk factors. In both the main cohort and BPH subcohort, the use of any 5ARI did not increase the risk of cardiovascular disease (HR = 1.06; 95% CI = 0.91–1.23; HR = 0.95; 95% CI = 0.88–1.03; respectively). Furthermore, as an unexpected finding, a dose-analysis among the BPH subcohort showed that the highest tertile of 5ARI exposure reduced the risk of CVD (HR = 0.82; 95% CI = 0.72–0.92; p-trend = 0.001), MI (HR = 0.69; 95% CI = 0.50–0.95), and stroke (HR = 0.84; 95% CI = 0.72–0.98) compared to non-users. Among men and BPH patients, 5ARI did not increase the risk of CVD. Among BPH patients, 5ARI use may reduce the risk CVD.

scholarly journals MSR1 variants and the risks of prostate cancer and benign prostatic hyperplasia: a population-based study in China

2007 ◽  
Vol 28 (12) ◽  
pp. 2530-2536 ◽  
Author(s):  
A. W. Hsing ◽  
L. C. Sakoda ◽  
J. Chen ◽  
A. P. Chokkalingam ◽  
I. Sesterhenn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Benign Prostatic Hyperplasia ◽  
Population Based ◽  
Prostatic Hyperplasia ◽  
Population Based Study

scholarly journals Population Based Trends in the Surgical Treatment of Benign Prostatic Hyperplasia

2012 ◽  
Vol 188 (5) ◽  
pp. 1837-1841 ◽  
Author(s):  
Florian R. Schroeck ◽  
John M. Hollingsworth ◽  
Samuel R. Kaufman ◽  
Brent K. Hollenbeck ◽  
John T. Wei
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Population Based ◽  
Prostatic Hyperplasia

scholarly journals Allopurinol and risk of benign prostatic hyperplasia in a Finnish population-based cohort

2017 ◽  
Vol 21 (3) ◽  
pp. 373-378 ◽  
Author(s):  
Ville Kukko ◽  
Antti Kaipia ◽  
Kirsi Talala ◽  
Kimmo Taari ◽  
Teuvo L. J. Tammela ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Population Based ◽  
Prostatic Hyperplasia ◽  
Finnish Population

scholarly journals Cost analysis of fixed-dose combination of dutasteride and tamsulosin compared with concomitant dutasteride and tamsulosin monotherapy in patients with benign prostatic hyperplasia in Canada

2014 ◽  
Vol 8 (1-2) ◽  
pp. 1 ◽  
Author(s):  
Amyn P. Sayani ◽  
Afisi S. Ismaila ◽  
Anna Walker ◽  
John Posnett ◽  
Bruno Laroche ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Lifetime Cost ◽  
Treatment Options ◽  
Prostatic Hyperplasia ◽  
Fixed Dose Combination ◽  
Fixed Dose ◽  
Effective Treatment Option ◽  
Health States ◽  
Cost Effective Treatment ◽  
Dose Combination

Introduction: We estimate the lifetime cost of treatment for moderate/severe symptoms associated with benign prostatic hyperplasia (BPH) in a cohort of Canadian men aged 50 to 59, and we evaluate the costs of 2 daily bioequivalent treatment options: fixed-dose combination (FDC) of dutasteride (0.5 mg) and tamsulosin (0.4 mg), or concomitant administration of dutasteride (0.5 mg) and tamsulosin (0.4 mg) monotherapies.Methods: The expected lifetime costs were estimated by modelling the incidence of acute urinary retention (AUR), BPH-related surgery and clinical progression over a patient’s lifetime (up to 25 years). A model was developed to simulate clinical events over time, based on a discrete Markov process with 6 mutually exclusive health states and annual cycle length.Results: The estimated lifetime budget cost for the cohort of 374 110 men aged 50 to 59 in Canada is between $6.35 billion and $7.60 billion, equivalent to between $16 979 and $20 315 per patient with moderate/severe symptoms associated with BPH. Costs are lower for FDC treatment, with the net difference in lifetime budget impact between the 2 treatment regimens at $1.25 billion. In this analysis, the true costs of BPH in Canada are underestimated for 2 main reasons: (1) to make the analysis tractable, it is restricted to a cohort aged 50 to 59, whereas BPH can affect all men; and (2) a closed cohort approach does not include the costs of new (incident) cases.Conclusion: Canadian clinical guidelines recommend the use of the combination of tamsulosin and dutasteride for men with moderate/severe symptoms associated with BPH and enlarged prostate volume. This analysis, using a representational patient group, suggests that the FDC is a more cost-effective treatment option for BPH. 

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