World J Mens Health.
2021 Jan;39(1):83-89. 10.5534/wjmh.190166.
A National Analysis of Temporal Changes in Prescribing of Testosterone Replacement Therapy Considering Methods of Delivery and Government Regulation
- Morton A
1,2 - Williams M1,2
- Perera M1,2,3
- Ranasinghe S1,2
- Teloken PE1,2
- Williams M4
- Chung E1,5,6
- Roberts MJ2,7,8
- Affiliations
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- 1Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- 2Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- 3Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia.
- 4School of Medicine, University of Sydney, Sydney, Australia.
- 5Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.
- 6Andro Urology Centre, Brisbane, Australia.
- 7Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia.
- 8Centre for Clinical Research and Faculty of Medicine, The University of Queensland, Herston, Australia.
- KMID: 2509583
- DOI: http://doi.org/10.5534/wjmh.190166
Abstract
- Purpose
Testosterone replacement therapy (TRT) is commonly used for various causes of androgen deficiency and subsidized by the Pharmaceutical Benefits Scheme (PBS) in Australia when appropriate. In response to a sharp increase in the prescribing of subsidized TRT, the Australian government instituted new, stricter prescription criteria in April 2015. We aim to demonstrate longitudinal changes in the prescription patterns of subsidized TRT over time.
Materials and Methods
The publicly available PBS database was accessed for TRT prescription data between 1992–2018. Population estimate data was collected from the Australian Bureau of Statistics for population-adjustment. Data analysis was performed according to class and specific formulation of TRT. Total and population-adjusted trends were considered, as was indexation to 2015 when restrictions were implemented.
Results
Longitudinal trends in subsidized TRT prescription demonstrated a progressive overall increase since 2000, according to total prescriptions and population-adjusted estimates, with greater use of topical formulations (gel, patch, cream/spray) and injections. Since 2015, a 37% decline in total population-adjusted prescriptions was observed (1,399–883 per 100,000 persons). Since 2015, relatively increased use of injections (50%) and 1% gel (30%) comprise the majority of contemporary TRT. Annual financial burden due to TRT was $AU16,768 per 100,000 persons prior to 2000 (mean cost 1992–2000), increasing to $AU112,539 in 2018 (due to use of injections). The rate of change in costs slowed after the restrictions were introduced in 2015.
Conclusions
The restrictions in subsidized TRT eligibility enforced by the PBS have reduced overall TRT prescriptions and slowed the cumulative financial burden.
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