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Potential Impact in the United States

Steven J. Jacobsen, MD, PhD; Cynthia J. Girman, DrPH; Harry A. Guess, MD, PhD; Joseph E. Oesterling, MD; Michael M. Lieber, MD

Arch Intern Med. 1995;155(5):477-481.

Abstract
Background
The Agency for Health Care Policy and Research (AHCPR) recently released the clinical practice guidelines for the diagnosis and treatment of benign prostatic hyperplasia. Prevalence estimates from a population-based cross-sectional study, the baseline component of a cohort study of the natural history of prostatism, were used to assess their potential impact in the United States.

Methods
The study group comprised a population-based sample of white men aged 50 to 79 years who were randomly selected within age- and residence-specific strata from the Olmsted County, Minnesota, population (1990 census, 105 720). These 1317 men completed symptom assessments and diagnostic evaluations that paralleled the AHCPR guidelines, including the measurement of urinary flow rates and, for a subset (n=303), ultrasonic determination of postvoiding residual urine volume.

Results
The application of the AHCPR benign prostatic hyperplasia diagnostic guidelines to the study cohort (American Urologic Association Symptom Index >7 and peak urinary flow rate < 15 mL/s) suggests that 17% of men aged 50 to 59 years, 27% of men aged 60 to 69 years, and 35% of men aged 70 to 79 years are eligible to discuss treatment options. Application of these percentages to the 1990 US white population suggests that approximately 5.6 million men aged 50 to 79 years are eligible to discuss treatment options. This number will double by the year 2020 owing to the aging of the population.

Conclusion
The projected number of men potentially meeting AHCPR guidelines to discuss treatment options for benign prostatic hyperplasia could have a substantial impact on the health care system; this will be compounded by the aging of the population.

(Arch Intern Med. 1995;155:477-481)

Author Affiliations
From the Department of Health Sciences Research, Section of Clinical Epidemiology (Drs Jacobsen, Girman, and Guess), and the Department of Urology (Dr Lieber), Mayo Clinic and Mayo Foundation, Rochester, Minn; Merck Research Laboratories, Blue Bell, Pa (Drs Girman and Guess); and the Michigan Prostate Institute and the Division of Urology, University of Michigan, Ann Arbor (Dr Oesterling).

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