A widespread population study of actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia across Europe and beyond official clinical guidelines.

BACKGROUND

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.

OBJECTIVE

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.

MEASUREMENTS

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.

RESULTS AND LIMITATIONS

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.

CONCLUSIONS

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.