Patients electing BPH surgery may hope to cease BPH medical therapy. However, some patients may continue or begin medication to treat residual symptoms. Data is limited regarding medical therapy use following traditional and minimally invasive surgical treatments (MISTs) for BPH. In this large-scale real-world analysis, we explore continued and de novo BPH medical therapy rates following TURP, GreenLight PVP and UroLift PUL procedures in a large database of US healthcare claims.
Methods:
36,629 patients who underwent outpatient TURP (n=20,319), GreenLight (n=10,517), or PUL (n=5,793) with ≥1 year of follow-up were identified within this representative sample of 2015-2021 Medicare and commercial claims. Pharmaceutical claims were linked to assess rates of continuous and de novo use of alpha-blocker, 5ARI, or combination therapy, including only patients with ≥2 medical therapy Rx following BPH surgery. Perioperative medication usage was defined as ≥2 med Rx within 3mo only; prolonged use was examined through 1- and 5 yrs post-op.
Results:
Perioperative medical therapy rates were similar between all treatment groups. 1yr: The rate of continued use following PUL, TURP and PVP was 2.5%, 4.0% and 4.2%, respectively. De novo use was low after all therapies yet lowest for PUL (0.5%) and similar between TURP (0.9%) and PVP (1.0%). The total 1yr medical therapy rate was lowest for PUL at 3.9% (TURP 6.1%; PVP 6.5%). 5yr: Medical therapy use increased following all procedures through 5 yrs. Rates of continued and de novo use were: PUL (8.4% cont.; 1.0% de novo), TURP (7.0% cont.; 2.0% de novo) and PVP (7.2% cont.; 1.7% de novo). The total 5yr medical therapy rate was similar between PUL (10.3%), TURP (10.2%) and PVP (10.2%). Alpha-blockers were the leading BPH drug class utilized through 1- and 5yrs post-PUL, TURP and PVP.
Conclusions:
Post-surgery medication use is a relatively unexplored factor of the BPH patient journey. Rates of medication use through 1yr were higher following TURP and PVP compared to PUL, and were equivalent at 5yrs. This may indicate that in a real-world setting, TURP and PVP patients could have more advanced disease that doesn’t fully respond to that intervention. The 5yr rate of medication usage for PUL is similar to the rate demonstrated in the LIFT pivotal trial (10.3% vs 10.7% LIFT).
Source of funding:
NeoTract/Teleflex Inc
