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Association of Physician Specialty and Medical Therapy for Benign Prostatic Hyperplasia

Han, Leona C., MBA*; Kim, Simon P., MD, MPH†,‡; Gross, Cary P., MD‡,§; Ross, Joseph S., MD, MHS§; Van Houten, Holly K., BA; Smaldone, Marc C., MD; Krambeck, Amy E., MD#; Shah, Nilay D., PhD

doi: 10.1097/MLR.0000000000000078
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Background: Despite little available evidence to determine whether recently introduced selective α-1 blockers and 5-α reductase inhibitors (5-ARIs) are superior to the existing agents in treating benign prostatic hyperplasia (BPH), they are being increasingly prescribed.

Objective: To describe the prescribing patterns of new and existing agents among patients with incident BPH after the introduction of several new agents and determine whether these varied by physician specialty.

Research Design: We analyzed a retrospective cohort from an administrative claims database from January 2004 through December 2010.

Subjects: Patients diagnosed with incident BPH aged 40 years and above and those who received medical management.

Measures: Receipt of medical therapy for incident BPH (ie, selective α-1 blockers [prazosin (released 1976), terazosin (1987), doxazosin (1990), tamsulosin (1997), alfuzosin (2003), silodosin (2009)] and 5-ARIs [finasteride (1992) and dutasteride (2002)]).

Results: A total of 42,769 men with incident BPH received any selective α-1 blocker or 5-ARI. Tamsulosin and dutasteride were the most widely prescribed agents of their respective drug classes. Predicted probabilities showed that urologists were more likely to prescribe alfuzosin (24.0% vs. 7.8%; P<0.001) and silodosin (2.3% vs. 0.4%; P<0.001) when compared with primary care providers (PCPs) at 6 months after diagnosis. Urologists were more likely to prescribe 5-ARIs but less likely to prescribe older α-1 blockers (terazosin, prazosin, and doxazosin) than PCPs at 6 months postdiagnosis.

Conclusions: Among insured patients diagnosed with BPH, our study suggests that the overall use of new agents is rising. In particular, urologists were more likely to prescribe newer selective α-1 blockers compared with PCPs.

*Department Administrative Services—Research, Mayo Clinic, Rochester, MN

Department of Urology, Yale University School of Medicine

Cancer Outcomes Public Policy and Effectiveness Research Center, Yale University

§Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT

Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN

Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA

#Department of Urology, Mayo Clinic, Rochester, MN

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.lww-medicalcare.com.

Supported by the Healthcare Delivery and Research Scholars Program, Mayo Clinic, Rochester, MN. J.S.R. is supported by the National Institute on Aging (K08 AG032886) and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program.

C.P.G. and J.S.R. report being members of a scientific advisory board for FAIR Health Inc. and receiving research support from Medtronic Inc. to develop methods of clinical trial data sharing. J.S.R. also reports receiving research support from the Centers of Medicare and Medicaid Services (CMS) to develop and maintain performance measures that are used for public quality reporting, from Pew Charitable Trusts to examine pharmaceutical regulatory actions, and from the Food and Drug Administration (FDA) to develop methods for post-market surveillance of medical devices. The remaining authors declare no conflict of interest.

Disclosure: The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from the following IMS Health Incorporated information service(s): LifeLink Health Plan Claims Database™ (2000-2010), IMS Health Incorporated. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary entities.

Reprints: Simon P. Kim, MD, MPH, Yale University, Department of Urology, PO Box 208058, New Haven, CT 06519. E-mail: simkim@me.com.

© 2014 by Lippincott Williams & Wilkins.