title: Utilization and cost of sildenafil in a large managed care organization with a quantity limit on sildenafil.
abstract: OBJECTIVE
  Erectile dysfunction (ED) affects approximately 30 million men in the United States. The objectives of this study were to (1) assess the cost and utilization of sildenafil citrate (Viagra), an oral therapeutic agent for ED, in a large managed care organization (MCO) with a quantity limit of 6 units per 30-day supply and (2) describe the incidence of comorbid conditions and the severity of cardiovascular disease in adult male users of sildenafil.
  
  
  METHODS
  Pharmacy claims for sildenafil were identified from an administrative database of claims with dates of service in calendar year 2001 for male members aged 18 years or older. Medical claims for MCO members who had sildenafil claims were used to identify comorbid diseases and categorize patients by degree of cardiovascular risk. High risk was defined as having at least 1 medical claim with a diagnosis of diabetes mellitus, ischemic heart disease, abdominal aortic aneurysm, or peripheral arterial disease, and medium risk was defined as not having any diagnosis in the high-risk category but at least 1 cardiovascular risk factor that included smoking, hypertension, hypercholesterolemia, family history of premature coronary heart disease, or being aged 45 years or older.
  
  
  RESULTS
  There were 67,914 pharmacy claims for sildenafil during 2001 for 20,281 MCO members, an average of 3.3 pharmacy claims per patient. The prevalence of sildenafil use was 54.1 per 1,000 male MCO members aged 18 years or older. The total allowed charges for sildenafil pharmacy claims in 2001 were 3.56 million US dollars, of which patients paid 26.6% in average cost-share, and the net MCO cost per member per month (PMPM) was 0.18 US dollars. A total of 1,681 patients (8.3%) exceeded their quantity restrictions for sildenafil tablets in 2001, of which 1,362 (81.0%) paid cash and 319 (19.0%, or 1.6% of all sildenafil users) appealed and received approval from the MCO for additional sildenafil tablets beyond the restriction of 6 tablets per month. Medical claims were available for 15,644 sildenafil patients (77.1%), and 12,720 sildenafil users (81.3% of those with medical claims) were judged to be at high or medium cardiovascular risk.
  
  
  CONCLUSIONS
  A quantity limit of 6 tablets of sildenafil per 30-day period was associated with a drug cost to users and the MCO of 0.25 US dollars PMPM. Sildenafil users paid an average cost-share of 26.6%, resulting in a net drug cost of 0.18 US dollars PMPM to the MCO.
authors.affiliation: Clinical Education Consultant, Pfizer Inc., 5106 Bonnie Branch Rd., Ellicott City, MD 21043, USA. catherine.cooke@pfizer.com
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Cooke
authors.forename: Winston
authors.initials: W
authors.lastname: Wong
authors.forename: Helen
authors.initials: H
authors.lastname: Lee
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003363:Cost Control / Q000191:economics / Q000379:methods; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000458:organization & administration; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011687:Purines; D012307:Risk Factors; D000068677:Sildenafil Citrate; D013450:Sulfones; D013997:Time Factors
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate