The cost-effectiveness of sildenafil.
BACKGROUND
Coverage of sildenafil by health insurance plans is a contentious issue.


OBJECTIVE
To evaluate the cost-effectiveness of sildenafil treatment for erectile dysfunction.


METHODS
A Markov decision model to estimate the incremental cost-effectiveness of sildenafil compared with no drug therapy.


METHODS
Values for the efficacy and safety of sildenafil and quality-of-life utilities were obtained from the published medical literature. Base-case values were chosen to bias against sildenafil use.


METHODS
Men 60 years of age with erectile dysfunction.


METHODS
Lifetime.


CONCLUSIONS
Societal and third-party payer.


METHODS
Sildenafil or no treatment in identical hypothetical cohorts.


METHODS
Cost per quality-adjusted life-year (QALY) gained.


RESULTS
The cost per QALY gained for sildenafil treatment compared with no therapy was $11,290 from the societal perspective and $11,230 from the third-party payer perspective.


RESULTS
From the societal perspective, the cost per QALY gained associated with sildenafil was less than $50,000 if treatment-related morbidity was less than 0.8% per year, mortality was less than 0.55% per year, treatment was successful in more than 40.2% of patients, or sildenafil cost less than $244 per month. The results were sensitive to variation of erectile dysfunction utilities, but cost per QALY gained was less than $50,000 if successful treatment increased utility values by 0.05 or more on a scale of 0 (death) to 1 (perfect health).


CONCLUSIONS
In an analysis biased against use of sildenafil, the cost-effectiveness of sildenafil treatment compared favorably with that of accepted therapies for other medical conditions.
Smith
K J
KJ
Mercy Hospital of Pittsburgh and the Center for Research on Health Care, University of Pittsburgh School of Medicine, Pennsylvania, USA. ksmith@pmhs.mercy.org
Roberts
M S
MS
D015106:3',5'-Cyclic-GMP Phosphodiesterases / Q000037:antagonists & inhibitors*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D010879:Piperazines / Q000191:economics* / Q000627:therapeutic use; D011687:Purines; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D000068677:Sildenafil Citrate; D013450:Sulfones; D014481:United States
D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D015106:3',5'-Cyclic-GMP Phosphodiesterases