Department of Urology, Tenon Hospital, Groupe Hospitalo-Universitaire EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France.
Eur Urol. 2010 Sep;58(3):450-6. doi: 10.1016/j.eururo.2010.05.045. Epub 2010 Jun 9.
The estimated prevalence of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) in men >50 yr of age is around 30%, similar in all industrialized countries. alpha(1)-Blockers and 5 alpha-reductase inhibitors (5-ARIs) are the two classes of drugs recommended by the European Association of Urology guidelines for the medical management of LUTS/BPH.
To compare actual clinical practice across Europe with guidelines, we assessed the use of all BPH-related drugs (alpha(1)-blockers, 5-ARIs, and plants) among European countries with a large-scale quantitative and descriptive study.
DESIGN, SETTING, AND PARTICIPANTS: The amounts of BPH-related drugs prescribed in 19 European countries were obtained from the IMS Health database retrospectively from 2004 to 2008. Data were adjusted for each country by the number of people >50 yr of age.
We determined the "prescription index" related to BPH, defined for each drug per country by days of treatment sold per year divided by the number of men at risk divided by 365 d.
From 2004 to 2008, the yearly number of prescriptions was 11.6 million for 74 million people at risk. The global prescription index increased in all countries and was three-fold more important in southern countries than in northern ones. alpha(1)-Blockers are the most widely prescribed drugs, but the share of 5-ARIs is increasing. Phytotherapy prescription is country specific, varying from 0% to 40% of prescriptions and is not recommended by the guidelines.
Major variations were seen among European countries concerning the prescriptions related to BPH, although the prevalence of the disease and the guidelines are similar. These results underline the importance of feedback from actual clinical practice. Analysis of actual prescription levels would complement evidence-based medicine as critical material for public health analysis, recommendations, and health insurance policies.
50 岁以上男性良性前列腺增生相关下尿路症状（LUTS）的估计患病率约为 30%，在所有工业化国家中相似。α1-阻滞剂和 5α-还原酶抑制剂（5-ARI）是欧洲泌尿外科学会指南推荐用于 LUTS/BPH 药物治疗的两类药物。
为了与指南比较欧洲各国的实际临床实践，我们通过一项大规模的定量和描述性研究评估了欧洲各国使用所有与前列腺增生相关的药物（α1-阻滞剂、5-ARI 和植物制剂）的情况。
设计、设置和参与者：2004 年至 2008 年，我们从 IMS Health 数据库中获得了 19 个欧洲国家开具的前列腺增生相关药物的数量，并根据各国 50 岁以上的人口数量进行了调整。
我们确定了每个国家每个药物的“处方指数”，该指数定义为每年每治疗日除以风险人群中男性人数除以 365 天。
2004 年至 2008 年，风险人群中 7400 万人的年处方数为 1160 万。所有国家的年处方数都在增加，南方国家的处方数是北方国家的三倍多。α1-阻滞剂是最广泛使用的药物，但 5-ARI 的份额正在增加。植物药的处方具有国家特异性，从处方的 0%到 40%不等，并且不符合指南的建议。
尽管疾病的流行程度和指南相似，但欧洲各国之间在与前列腺增生相关的处方方面存在较大差异。这些结果强调了从实际临床实践中获得反馈的重要性。对实际处方水平的分析将作为公共卫生分析、建议和健康保险政策的重要材料，补充循证医学。
