Lanes S F, Sulsky S, Walker A M, Isen J, Grier C E, Lewis B E, Dreyer N A
Epidemiology Resources Inc., Newton Lower Falls, Massachusetts, USA.
Clin Ther. 1996 Sep-Oct;18(5):993-1004. doi: 10.1016/s0149-2918(96)80055-5.
We assessed the frequency and cost of care for benign prostatic hyperplasia (BPH) among approximately 165,000 subscribers to Fallon Community Health Plan (FCHP), a group model health maintenance organization located in central Massachusetts. We computed rates of episodes of medical services for BPH using automated utilization files, and we estimated costs using Medicare reimbursement schedules and medication average wholesale prices. We identified 3919 men who visited a physician for BPH from January 1, 1991, until December 31, 1994, during which time they contributed 8336 person-years to the analysis. This population comprises approximately 12% of men at least 40 years old at FCHP. From 1991 to 1994, 696 (18%) men received terazosin, 219 (6%) men underwent a prostatectomy, and 41 (1%) men received finasteride. Men averaged 1.66 office visits per year to a physician for BPH. Most office visits (61%) were to a primary care physician, with 39% of the visits to a urologist. Among patients who received terazosin, the frequency of office visits increased slightly after receiving terazosin, from 2.14 to 2.62 visits per year. Among surgery patients, the frequency of visits declined after prostatectomy, from 6.31 visits per year to 1.67 visits. The individual annual cost rate for BPH care ranged from $25.00 to $25,352.00, with an average of $364.00 per person and a median cost of $126.00. The major components of the overall costs were hospital admissions (35%), terazosin dispensings (29%), and physician office visits (19%), with outpatient hospital care and ambulatory procedures accounting for the remaining 17%. Among men receiving terazosin, the average cost was $1190.00 per person-year, and among patients undergoing prostatectomy, the cost was $2630.00 per person-year. The prostatectomy rate declined by nearly 80% during the study period, while the dispensing rate for terazosin doubled, resulting in an overall decline in the total cost of care for BPH from 1991 to 1994.
我们评估了位于马萨诸塞州中部的团体模式健康维护组织法伦社区健康计划（FCHP）约165,000名订阅者中良性前列腺增生（BPH）的护理频率和成本。我们使用自动化利用文件计算BPH医疗服务的发作率，并使用医疗保险报销时间表和药品平均批发价格估算成本。我们确定了从1991年1月1日至1994年12月31日期间因BPH就诊的3919名男性，在此期间他们为分析贡献了8336人年。该人群约占FCHP中至少40岁男性的12%。1991年至1994年期间,696名（18%）男性接受了特拉唑嗪治疗，219名（6%）男性接受了前列腺切除术，41名（1%）男性接受了非那雄胺治疗。男性每年因BPH平均看医生1.66次。大多数就诊（61%）是看初级保健医生，39%的就诊是看泌尿科医生。在接受特拉唑嗪治疗的患者中，接受特拉唑嗪治疗后就诊频率略有增加，从每年2.14次增加到2.62次。在手术患者中，前列腺切除术后就诊频率下降，从每年6.31次降至1.67次。BPH护理的个人年成本率从25.00美元到25,352.00美元不等，平均每人364.00美元，中位数成本为126.00美元。总成本的主要组成部分是住院（35%）、特拉唑嗪配药（29%）和医生门诊（19%），门诊医院护理和门诊手术占其余17%。在接受特拉唑嗪治疗的男性中，平均成本为每人每年1190.00美元，在接受前列腺切除术的患者中，成本为每人每年2630.00美元。在研究期间，前列腺切除率下降了近80%，而特拉唑嗪的配药率翻了一番，导致1991年至1994年BPH护理总成本总体下降。
