ABSTRACT
Background: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common problem among aging men. Several classes of drugs are efficacious and safe, but the first-line treatment is with alpha-1 adrenergic blockers. They provide symptomatic relief and have to be taken for a longer duration to sustain the effect. The preferred alpha-blockers among the stockpile should be efficacious, tolerable, and also cost-effective. Aim and Objective: This study focuses to compare the cost-effectiveness of various alpha blockers prescribed in patients with LUTS-BPH. Materials and Methods: An observational study of 78 patients who were newly diagnosed with LUTS-BPH from April 2014 to May 2015 was conducted. Patients were followed up at 4 weeks and at 12 weeks after the drugs had been prescribed. Efficacy assessment was done on basis of change in International Prostate Symptom Score (IPSS) score over 12 weeks. Average cost-effectiveness ratio of different alpha-blockers prescribed was evaluated and compared with Mann-Whitney U test in order to find the most cost-effective alpha-blocker in the study. Results: All patients were prescribed alpha-blockers either alone or in combination with other drugs. Tamsulosin was prescribed to n = 46, Silodosin to n = 16 and Alfuzosin to n = 16. The efficacy in terms of Mean change in IPSS after 12 weeks of study was 11.34 ± 5.23 for Tamsulosin, 11.70 ± 5.9 for Silodosin and 10.87 ± 4.77 for Alfuzosin and average cost-effectiveness ratio was 108.74, 183.07 and 127.50 for Tamsulosin, Silodosin, and Alfuzosin, respectively. Conclusion: Tamsulosin was the most cost-effective drug among the prescribed alpha-blockers. Since all the prescribed alpha-blockers had comparable efficacy so we concluded that the most cost-effective drug should be preferred for long-duration treatment.
ABSTRACT
Aim: Human infertility is a public problem and a cause of social and psychological complications affecting more than 50 million couples globally. Bisphenol A (BPA) is a ubiquitous environmental endocrine disrupting chemical and has been associated with infertility problems in women.The aim of the present study was to analyze concentrations of bisphenol A and circulating hormones in infertile Saudi women for evaluating the association of BPA with infertility.Methodology: The present study was done on 43 infertile women for evaluating possible association of systemic BPA concentrations with infertility in Saudi Arabia. The clinical indications were irregular menses, hyper-androgenism, multiple small ovarian cysts, polycystic ovarian syndrome and unexplained infertility. Blood samples from infertile women and a control group of 18 healthy fertile women were analyzed and compared for concentrations of BPA and circulatory hormones. Results: The results showed that BPA concentrations were not significantly different between infertile women and controls. BPA concentrations were also not correlated with systemic hormone concentrations in infertile women. Interpretation: Serum BPA levels had no association with hormone imbalance in this cohort of infertile Saudi women. However, considering the previous studies that have shown a relationship of BPA with female infertility, an argument can be made that there might be lower exposure of Saudi population to BPA in comparison to BPA analogues such as BPS (according to recent reports). Therefore, it is suggested to conduct more infertility studies that include detection of BPA and its analogues in infertile Saudi women