Evolution of healthcare costs for lower urinary tract symptoms associated with benign prostatic hyperplasia

Abstract

Purpose

With the ubiquity of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) in older men, costs related to this highly prevalent disease are likely significant but not well defined. With this study, we hoped to define costs related to LUTS/BPH care.

Methods

We utilized the Optum^© de-identified Clinformatics® Data Mart Database (CDM) for privately insured male enrollees aged 40–64 years with LUTS/BPH (N ≈ 100,300 annually) and the Centers for Medicare and Medicaid Services Medicare 5% Sample for male beneficiaries aged 65 + years with LUTS/BPH (N ≈ 147,800 annually). Annual LUTS/BPH-related expenditures from 2004 to 2013 were age standardized and calculated overall and by age and service location.

Results

The Medicare cohort demonstrated a 23% increase in total costs over the study period with a 28% decrease in CDM costs. Decreases in inpatient hospital charges (45% for Medicare, 55% for CDM) were offset by increasing hospital-based outpatient fees (120% for Medicare, 87% for CDM). Overall, we estimated a total cost of at least $1.9 billion for treatment of men with LUTS/BPH for 2013. Per person expenditures increased with age within cohorts with an average per-person cost of $269 (CDM) and $248 (Medicare) in 2013.

Conclusion

The distribution of healthcare expenditures for LUTS/BPH shifted across practice settings from 2004 to 2013, with increasing outpatient relative to inpatient expenditures. Total direct costs for LUTS/BPH in 2013 were at least $1.9 billion, not accounting for indirect costs or certain unmeasured populations.

Appendices

Appendices

Appendix A. ICD-9-CM diagnostic codes indicative of BPH

Code	Description
594.1	Other calculus in bladder
599.6	Urinary obstruction
599.60	Urinary obstruction, unspecified
599.69	Urinary obstruction, not elsewhere classified
600	Hyperplasia of prostate
600.0	Hypertrophy (benign) of prostate
600.00	Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptoms
600.01	Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms
600.1	Nodular prostate
600.10	Nodular prostate without urinary obstruction
600.11	Nodular prostate with urinary obstruction
600.2	Benign localized hyperplasia of prostate
600.20	Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms
600.21	Benign localized hyperplasia of prostate with urinary obstruction and other lower urinary tract symptoms
600.9	Hyperplasia of prostate, unspecified
600.90	Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary tract symptoms
600.91	Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary tract symptoms

1. ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification, BPH benign prostatic hyperplasia

Appendix B. Place of service definitions for Medicare and CDM claims

Place of service	Medicare 5% Sample	CDM
Inpatient hospital	Any claim from the inpatient (IP) files OR Any non-institutional claim with a place of service of “inpatient hospital”	Any claim from the Inpatient Confinement tables OR Any claim from the Medical tables with a place of service of “inpatient hospital”
Hospital-based outpatient	Any claim from the hospital outpatient (OP) files OR Any non-institutional claim with a place of service of “outpatient hospital”, “emergency room”, or “ambulatory surgical center”	Any claim from the Medical tables with a place of service of “outpatient hospital”, “emergency room”, or “ambulatory surgical center”
Physician office	Any non-institutional claim with a place of service of “office”	Any claim from the Medical tables with a place of service of “office”
Other	Any claim not described above	Any claim not described above

1. CDM Optum^© De-identified Clinformatics® Data Mart Database