Lower urinary tract symptoms suggestive of benign prostatic obstruction--Triumph: design and implementation

Lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) are likely to become an increasing burden for health care budgets in the future due to the high prevalence of this condition in the elderly and the ageing of the population. Data on the cost-effectiveness of the available treatment options in order to promote rational management will therefore be crucial. As this information is currently largely lacking, the European Association of Urology (EAU) has endorsed the formation of a Pan-European Expert Panel that has developed the Triumph (TransEuropean Research Into the Use of Management Policies for LUTS suggestive of BPH in Primary Healthcare) project. The Triumph project will evaluate how LUTS suggestive of BPO is currently managed in real life practice in initially 6 European countries (France, Germany, Italy, Poland, Spain and the UK) and how this condition progresses over time in relation to an initial treatment choice. In other words, how many patients remain on their initial therapy, how many switch to another therapy (including surgery) and within which time frame and how many develop serious complications related to BPO such as acute urinary retention. The clinical data will be retrieved from continuous analysis of large computer-based patient files such as the General Practice Research Database (GPRD) in the UK and the Integrated Primary Care Information (IPCI) database in The Netherlands. Furthermore, a cross-sectional, observational survey will gather similar data in a prospective fashion for at least 1 year from approximately 13,000 patients managed by more than 1,000 primary care physicians in all 6 countries. Both newly diagnosed (around 7,500) and existing (around 5,500) LUTS patients will be enrolled. For the existing patients in whom the diagnosis was made in the past (from January 1997 onwards), the relevant retrospective data (up to 3.5 years) on disease progression will also be collected. Finally, the costs associated with these treatments will be investigated by the development of a national costing database for each participating country that will detail costs related to visits, investigations, prescriptions, surgical interventions, etc. The last patient is anticipated to come out of the initial prospective survey by the end of 2002/beginning of 2003 and the results will hopefully contribute to improved cost-effective management of LUTS suggestive of BPO in the future.