Chronic prostatitis causes substantial health care costs and reduced quality of life

Patients with chronic prostatitis associated with chronic pelvic pain have substantial health care costs and have reduced quality of life, according to an article in the June 14 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a common disorder characterized by pelvic pain and lower urinary tract symptoms. Between 1990 and 1994, CPPS accounted for almost 2 million outpatient visits per year in the United States. Tests to diagnose CPPS are unreliable and the effectiveness of the most commonly prescribed treatments are not supported by existing evidence, the article states, and patients with CPPS report symptoms associated with depression and hypochondriasis.

Elizabeth A. Calhoun, Ph.D., from Northwestern University, Chicago, and colleagues examined the direct and indirect costs associated with chronic prostatitis among 167 men (average age, 44 years, 78 percent white) enrolled in the Chronic Prostatitis Cohort (CPC). Participants had pain in their pelvic region for at least three months within the last six months before joining the study, and responded to a questionnaire on use of health care resources. This information was used to calculate direct medical costs (based on hospital accounting data), and indirect costs (based on modified labor force, employment, and earnings data from the U.S. Census Bureau).

The researchers found that 82 percent of the participants accrued some costs over the three months prior to enrollment in the CPC. The average total costs (direct and indirect) for the three months were $1,099 per person, with an expected annual total cost per person of $4,397. Procedures and tests (average, $761) were responsible for the largest portion of direct costs, followed by health care visits (average, $325) and medication (average, $282). Of the men, 26 percent reported work loss valued at an average of $551.

Forty-nine percent of the participants had a procedure during the three months, with an average of six procedures during this time period. The most common procedures were urinalysis, urine culture and prostate massage. Of the participants, 64 percent saw a physician during these months, with an average of 5 visits per person (52 percent visited a urologist; 20 percent visited a primary care physician; 7 percent were seen in an urgent care or emergency department setting; and 6 percent saw an acupuncturist).

"We demonstrated that the management of prostatitis is associated with substantial direct and indirect costs," the authors write. "We believe that our estimate of cost is conservative, since we did not quantify the loss of work productivity reported by 79 percent of the study participants and did not include hospitalization costs.",


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