Medication Use Increases in VA LUTS/BPH Patients

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IOWA CITY, IA — The proportion of men who were prescribed pharmacotherapy within 90 days of diagnosis of lower urinary tract symptoms (LUTS) and related benign prostate hyperplasia (BPH) at the VA increased from 32.2% in 2003-2004 to 44.8% in 2009-2010.

The study examining trends in the medical management of BPH/LUTS at the VA was presented at the American Urological Association meeting in San Diego this past spring.1

Bradley Erickson, MD, and colleagues at the University of Iowa Carver College of Medicine in Iowa City, reported that the increase was greater among men age 40-59 than men age 60 or older.

The authors noted that LUTS from BPH affects nearly 75% of men by age 70, adding that “treatments for BPH/LUTS have changed considerably over the past decade with most men now receiving medication rather than surgery.”

Using VA administrative data to identify using relevant ICD9-CM codes 505,314 veterans 40 or older with a new diagnosis of BPH/LUTS from 2003-2010, the researchers then reviewed each patient’s pharmacy data from VA Pharmacy Benefits Management files. Changes over the study period were examined to determine the proportion of patients receiving BPH pharmacotherapy within 90 days of diagnosis. The secondary outcome measure was evaluation of changes in the category of medication prescribed, whether alpha-blockers (AB), 5-alpha reductase inhibitor (5ARI), anticholinergic (AC) or combination therapy.

Researchers found that alpha blockers were the most commonly prescribed drugs, and their use remained stable during the study period — 86.4% and 85.8% of prescriptions in 2003-2004 and 2009-2010, respectively.

On the other hand, 5-ARI use increased from 12.9% to 17% of prescriptions from 2003 to 2010, while the use of anticholinergic drugs decreased from 6.6% to 4.4% of prescriptions.

Other changes between 2003 and 2010 were that mean age at diagnosis declined from 69.0 to 65.8 years and the percentage of white patients declined from 70.2% to 65.8%.

“Between 2003 and 2010, we observed a decline in age at diagnosis of BPH/LUTS. We also observed a clinically significant increase in the proportion of men receiving pharmacotherapy within 90-days of diagnosis,” the authors presented. “Earlier age at BPH/LUTS diagnosis combined with earlier initiation of pharmacotherapy is likely to expose more men to a longer duration of treatment with uncertain long-term consequences.”

1. Erickson B, et al. (2013, May). Predictors of Initial Management for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms in the VA Healthcare System. Presented at the American Urological Association 2013 meeting, San Diego, CA.

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