1990年代の日本における前立腺肥大症治療の動向 ―厚生省統計資料に基づいた分析―

Abstract

1990年代の我が国における前立腺大症患者数や医療費の動向を総括する目的で厚生省の各種統計資料を分析した.総受療患者数は1987年20.2万人, 1995年33.5万人, 1998年59.0万人へと10年余りで2.9倍に増加し, 特に1995年以降の増加が著明であった.65歳以上の患者が全体の73～80%, 55歳以上が94～98%を占めていた.年間手術件数は5万件前後で, 明らかな年次的増加又は減少傾向は認められなかった.1988～1998年の間に総医療費は750億円から1, 400億円へとほぼ倍増した.入院医療費は総医療費の30～40%を占めていた.薬剤市場規模は1989年の300億円台から1998年には800億円を超えた.特に1995年以降, α遮断薬の使用患者数は24万人から45万人へと激増し, 全患者の70～77%に処方されるようになった

To review the contemporary management of benign prostatic hyperplasia (BPH) in Japan during 1990s, we analyzed several nationwide health statistics by the Ministry of Health and Welfare of Japan. The cross-sectional surveys revealed that the estimated total number of patients receiving treatment increased from 202, 000 in 1987, to 335, 000 and 590, 000, respectively, in 1995 and 1998. Approximately 73-80% of patients were men aged 65 years or over and 94-98% 55 years or older. Urologists treated two thirds of the BPH patients. The incidence of prostatectomies remained relatively stable at 50, 000/year (3.0-3.8 prostatectomies/1, 000 men aged 55 or over). The average hospital stay in 1996 was 24.7 days. The total cost of BPH therapy nearly doubled between 1988 and 1998. The ratio of outpatient to inpatient costs ranged from 1.5 to 2.2 and 60% of the outpatient cost was spent for medical therapy. The total value of the market for medical therapy increased from 30-40 billion yen in 1989 to more than 80 billion yen in 1998. The application of alpha-blockers increased from 243, 000 men (70% of all patients) in 1995 to 452, 000 (77%) in 1998, whereas the number of patients taking antiandrogens, plant extracts and antispasmodic agents/Ca antagonists (for pollakisuria), respectively, remained relatively stable at 60, 000-70, 000, 180, 000 and 300, 000. Because Japan is a rapidly aging society and men aged 55 or older are expected to increase from 15 million in 1995 to 21 million in 2010, cost-effective treatment guidelines for the Japanese BPH patients are needed.