Economic cost of male erectile dysfunction using a decision analytic model- For a hypothetical managed-care plan of 100 000 members

Objective: This paper examined the economic east of male erectile dysfuncti on (ED) for a hypothetical managed-care (MC) model. Design and Setting: A prevalence-based cost-of-illness approach was used to estimate the direct medical cost for ED treatment. A treatment plan algori thm was developed from a MC perspective to model the initial treatment sele ction of various patient groups [vacuum erection device, intracavernosal in jection (ICI) therapy, transurethral alprostadil suppository, sildenafil, t estosterone replacement therapy, penile prosthesis] and their therapy outco mes during a 3-year period. Overall cost was based on 1998 US dollars. Tota l direct medical cost of ED considered in this model included the cost of i nitial physician consultation and evaluation, the cost incurred by patients from various treatment groups (pharmacological and surgical options), as w ell as the cost related to patients' follow-up for treatment within the 3-y ear period. Consideration for therapy switches made by patients who failed initial therapy was included as part of the clinical assumptions for this m odel. Treatment response and expected outcomes (dropouts) were considered f or the various treatment options. Participants: A total of 100 000 enrolled members were included in the stud y. Main outcome measures and results: The total cost of ED was $US3 204 792 fo r the 3-year period in the hypothetical MC plan. The treatment portion acco unted for approximately 80% of the total cost while the cost of medical ser vices and diagnostic tests were minimal in comparison. The 3 year total cos t of nonsurgical treatment was $US2 473 045. Costs associated with each tre atment alternative were $US81 866 (testosterone transdermal patch), $US51 9 30 (vacuum erection device), $US384 624 (ICI therapy), $US226 1 83 (transur ethral alprostadil suppository) and $US 1 728 142 (sildenafil citrate). Res ultsfrom the model showed a noticeable trend of decreasing cost patterns ov er time and reflected the attrition observed for many of the standard medic al therapies for ED. Conclusions: Sildenafil and the vacuum erection device should be considered as first-line management strategies for ED whereas ICI therapy, transureth ral alprostadil suppository and penile prosthesis implant should be reserve d for second or third-line therapy. Because costs associated with switches related to successive treatment failures can be high, treatment considerati ons should, therefore, focus on achieving long term patient satisfaction. T he patient's preferred treatment choice, using goal-directed therapy during the initial consultation and evaluation visit, should be used.