Direct medical costs double in men with prostatitis

"Prostatitis is common, with a prevalence reported from 5% to 10% of men. Because we're seeing nearly double the costs for that share of the adult male population, that makes the cost burden very high," said study author J. Quentin Clemens, MD, MSci, assistant professor of urology at Northwestern University's Feinberg School of Medicine, Chicago.

He and colleagues at Northwestern and Kaiser Permanente Northwest in Portland, OR, analyzed medical costs over 5 years for 4,500 men who had a diagnosis of any kind of prostatitis, including the ICD-9 codes for acute prostatitis, chronic prostatitis, and prostatitis not otherwise specified. Based on age and duration in the health plan, each of those men was matched with three controls.

"The question comes that perhaps prostatitis patients' costs are higher because they happened to have more unrelated medical problems. Maybe they have more cancer or more heart disease or more diabetes," said Dr. Clemens.

But the team's analysis showed that those major medical conditions were equally common in the two groups.

However, other conditions-gastroesophageal reflux, allergic rhinitis, and asthma-occurred significantly more often in the prostatitis group than in the control group. Most of these conditions have been recognized as being more common in chronic prostatitis and interstitial cystitis populations than in the general population. The rate of obesity was less in the men with chronic prostatitis.

To pin down where the increased cost was coming from, the team looked at use of medications commonly prescribed for prostatitis and found they were uniformly used more commonly in the cases than in controls. For example, 28% of the prostatitis population had prescriptions for antibiotics averaging $241 annually each, whereas 15% of the controls did, costing only $56 per year.

The next most common medication among prostatitis patients was alpha-blockers, averaging $518 per year each and used in 10% of that population, whereas the annual cost was $45 for those medications used in only 3.5% of controls.

"We feel this shows that the costs are higher for prostatitis and that they are specific to prostatitis, rather than to other factors," Dr. Clemens said.

He hopes to examine the reasons for these high costs more closely. If misdiagnosis leads to more office visits and additional tests, then educating physicians about prostatitis would help bring down costs. In addition, catching the problem early might lead to better, more effective therapy, something that is being researched now in chronic prostatitis/chronic pelvic pain syndrome.

Whatever the increased costs are related to, said Dr. Clemens, "it reinforces that if we could identify a treatment that works, we could have a significant impact, not only a quality of life, but probably also a financial impact on the health system in general."