TREATMENT OF BENIGN PROSTATIC HYPERPLASIA - A PHARMACOECONOMIC PERSPECTIVE

Men with moderate symptoms of benign prostatic hyperplasia (BPH) are t he best candidates for medical treatment, while surgery is usually ind icated for patients with severe symptoms. Men with mild symptoms do no t usually need treatment, but they might be re-evaluated annually if d esirable, Finasteride, which produces selective hormonal deprivation, is now established as a well tolerated drug for the long term medical therapy of BPH, Recent studies suggest that finasteride is most effect ive in men with large prostates (>40ml), and the drug should probably be reserved for these patients. alpha-Blockers work in men with small or large prostates, and their rapid onset of action facilitates the id entification of responders. alpha-Blockers are more effective than fin asteride during the first year of treatment, but only finasteride indu ces regression of the prostate and offers increased efficacy over time , Even if drug therapy reduces the need for prostate surgery, the tota l economic cost of BPH treatment is likely to rise because of the incr easing application of medical treatment, The magnitude of this increas e depends largely on what percentage of the male population embark on long term therapy, at: what age treatment is started, and how successf ul it is. At present, the answers to these questions are largely unkno wn. The personal economic expenses for men who begin long term medical therapy will probably be an important factor in deciding how common d rug treatment for BPH will become in the future. Fur many men, the mai n benefit of drug treatment will be the relief of urinary symptoms, bu t whether this improvement is substantial enough to improve their over all quality of life has not yet been clearly demonstrated in controlle d studies.