Clinical Progression and Costs in Benign Prostatic Hyperplasia Patients Treated With Early Versus Delayed Combination Therapy
Clinical Progression and Costs in Benign Prostatic Hyperplasia Patients Treated With Early Versus Delayed Combination Therapy
In patients with benign prostatic hyperplasia (BPH), combination therapy with an
 alpha-blocker (AB) and a 5 alpha-reductase inhibitor (5ARI) has been shown to reduce the
 progression of acute urinary retention (AUR) and the incidence of prostate surgery, and also
 provides symptom relief.

 The objective of this study is to compare the likelihood of clinical progression (defined as
 AUR and/or prostate-related surgery) and costs in BPH patients who were treated with delayed
 combination therapy to BPH patients who were treated with early combination therapy using
 data from a United States (US) healthcare claims database. The hypothesis of this study is
 that patients who are prescribed combination therapy early in their BPH treatment will
 experience better clinical outcomes and lower healthcare costs compared with patients treated
 with delayed combination therapy. The null hypothesis is that no difference will be observed
 in outcomes or direct medical costs for patients treated with early combination therapy and
 patients treated with delayed combination therapy.

 The US healthcare claims database includes data from patients with Medicare Advantage as well
 as private health plan coverage including the Impact health plan. About 14 million people
 were covered by this set of health plans in 2007 and were geographically diverse across the
 US. Data from 2000 through 2009 were utilized.

 The study is a retrospective cohort analysis.
Inclusion Criteria:

 -  Male

 -  Age 50 or older at the index date (the date of the first filled prescription for an AB
 or 5ARI during the enrollment period)

 -  At least one claim with an ICD-9 diagnosis code for BPH (222.2 or 600.xx) in any
 position and at least one pharmacy claim for an AB (alfuzosin, doxazosin, tamsulosin,
 or terazosin) or at least one fill for a 5ARI (dutasteride or finasteride) (with or
 without a diagnosis for BPH)

 -  Continuous enrollment with medical and pharmacy benefits for 6 months prior to the
 index date (i.e., baseline period) and 12 months after the index date (follow-up
 period)

 Exclusion Criteria:

 -  At least one pharmacy claim for an AB (alfuzosin, doxazosin, tamsulosin, or terazosin)
 any time during the pre-index period prior to the index date

 -  At least one fill for a 5ARI (dutasteride or finasteride) any time during the
 pre-index period prior to the index date

 -  A diagnosis code for prostate cancer (ICD-9 = 185, 198.82, 233.4, 236.5, 239.5,
 V10.46) or bladder cancer (ICD-9 =188, 198.1, 223.3, 233.7, 239.4, V10.51) in any
 position during the pre-index or follow-up period

 -  A pharmacy claim for finasteride 1 mg tablets (i.e., treatment of male-pattern
 baldness) during the pre-index or follow-up period

 -  Prostate surgery anytime during the pre-index period or 5 months after the index date