Management of Symptomatic BPH in France: Who Is Treated and How?

Objective: To review the contemporary management of symptomatic benign prostatic hyperplasia (BPH) in France. Methods: Information was obtained from published scientific articles, IMS market analysis data and community-based surveys among older men. Results: The prevalence of symptomatic BPH in France is relatively high. About 15–20% of men over 50–60 years of age report moderate to severe lower urinary tract symptoms (LUTS: total I-PSS >7). If this is applied to the 5.7 million men aged 60 or over living in France, it seems that 855,000–1,140,000 men have symptomatic BPH. In the AFU-Synthélabo community-based survey, around half of these men (more than 10%) visited a physician because they were bothered by these symptoms interfering with performing daily life activities. This suggests that approximately 600,000 patients have a diagnosis of symptomatic BPH in France. These patients can contact both general practitioners (GPs) and urologists for the management of symptomatic BPH. Approximately one in every four to one in every three men with LUTS visits directly a urologist whereas the other 65–75% initially contacts a GP in France. GPs very often prescribe medical treatment for LUTS related to BPH. Of all medical prescriptions in France, 80% are made by GPs and only 12.5% by urologists. The total market for medical therapy increased substantially since 1994. Since 1998, it grew with 2–3%/year. A total of 640,000 patients received medical therapy for BPH in 1998. The growth in the medical treatment market was mainly due to an increase in the number of patients receiving α1-adrenoceptor antagonists. Today, this is the most frequently prescribed class of medical therapy (45.3%) followed by plant extracts (37.5%) who’s market share decreased slightly since 1996. The market share of finasteride is also still decreasing and represents today 17.2% of all prescriptions. The growth in the α1-adrenoceptor antagonist segment can mainly be attributed to the introduction of tamsulosin in 1996. The price for medical therapy in France is around 1 Euro/day and is estimated to be around 229 million Euro in 1998. All drugs are reimbursed for 35% by the Social Insurance. The number of prostatectomies has declined in France in the 1990s. A national database includes information from events taking place in all hospitals in France. It appears that a total of 66,431 surgical procedures for the prostate were done in 1997 of which 81% were performed transurethrally and 14% open. Total direct costs involved with these surgical procedures were 229 million Euro. Conclusions: The costs involved in the management of symptomatic BPH in France are very high. However, there still exist no official guidelines defining for GPs and urologists in a shared care environment how this condition should be diagnosed and in which situations which medical therapies should be prescribed or when surgery is indicated. The French urological association is playing a key role in improving treatment of BPH. Several initiatives are underway to observe real life practice by developing a national database for urology, promote studies to evaluate cost/effectiveness of each therapy, define national guidelines of good practice and develop the shared care concept with GPs.