Economic evaluation of treatment strategies for benign prostatic hyperplasia--is medical therapy more costly in the long run?

PURPOSE: Although medical therapy for newly diagnosed benign prostatic hyperplasia is initially less expensive than surgery, to our knowledge the long-term costs of these treatments are unknown. We defined longer term costs of these treatment strategies.
MATERIALS AND METHODS: We examined spending on benign prostatic hyperplasia related services by examining health care claims for a 5-year period subsequent to a new benign prostatic hyperplasia diagnosis. Expenditures for subjects treated initially with surgery were compared to expenditures for those with initial medical treatment. Expenditures were projected during longer periods and the net current value of these expenditures was calculated.
RESULTS: Of the 970 subjects identified who received benign prostatic hyperplasia treatment 913 (94.1%) relied on medical therapy as initial treatment. Of those subjects 832 (91.1%) were on alpha-blockers. The secondary treatment rates for surgery far exceeded those for medical therapy (37% vs 8%). Average total expenditures were higher for subjects who initially received surgery ($12,699, 95% CI 9,865-15,533) than for those initially treated with medication ($2,193, 95% CI 1,959-2,428). If future streams of spending were discounted at standard rates (3%), the costs of initial medical therapy as a treatment strategy would always be lower than those of initial surgical therapy even at 40 years.
CONCLUSIONS: In a cohort of privately insured men with newly diagnosed benign prostatic hyperplasia monotherapy with alpha-blockers was the most common initial treatment. Surgical therapy was associated with higher treatment failure rates and higher costs during 5 years. Increased expenditures related to initial surgical therapy were consistent when projected over long time frames.