Erectile dysfunction in spinal cord injury: a cost-utility analysis.
BACKGROUND
There is a high incidence of erectile dysfunction after spinal cord injury. This can have a profound effect on quality of life. Treatment options for erectile dysfunction include sildenafil, intracavernous injections of papaverine/alprostadil (Caverject), alprostadil/papaverine/phentolamine ("Triple Mix"), transurethral suppository (MUSE), surgically implanted prosthetic device and vacuum erection devices. However, physical impairments and accessibility may preclude patient self-utilization of non-oral treatments.


METHODS
The costs and utilities of oral and non-oral erectile dysfunction treatments in a spinal cord injury population were examined in a cost-utility analysis conducted from a government payer perspective. Subjects with spinal cord injury (n=59) reported health preferences using the standard gamble technique.


RESULTS
There was a higher health preference for oral therapy. The cost-effectiveness results indicated that sildenafil was the dominant economic strategy when compared with surgically implanted prosthetic devices, MUSE(R) and Caverject. The incremental cost-utility ratios comparing sildenafil with triple mix and vacuum erection devices favoured sildenafil, with ratios less than CAN$20,000 per quality adjusted life year gained.


CONCLUSIONS
Based on this study, we conclude that sildenafil is a cost-effective treatment for erectile dysfunction in the spinal cord injury population.
Mittmann
Nicole
N
Department of Pharmacology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue E240, Toronto, Ontario M4N 3M5, Canada. nicole.mittmann@sw.ca
Craven
B Catherine
BC
Gordon
Michael
M
MacMillan
D H Robert
DH
Hassouna
Magdy
M
Raynard
Warren
W
Kaiser
Anita
A
Lanctôt
L Krista
LK
Tarride
Jean-Eric
JE
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000191:economics; D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D007172:Erectile Dysfunction / Q000191:economics / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000008:administration & dosage / Q000191:economics; D010410:Penile Erection / Q000502:physiology; D015917:Penile Prosthesis / Q000191:economics; D010646:Phentolamine / Q000008:administration & dosage / Q000191:economics; D010879:Piperazines / Q000008:administration & dosage / Q000191:economics; D011687:Purines; D011788:Quality of Life; D012747:Sexual Partners; D000068677:Sildenafil Citrate; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000191:economics / Q000503:physiopathology; D013450:Sulfones; D011795:Surveys and Questionnaires; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000191:economics
D000317:Adrenergic alpha-Antagonists; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D010208:Papaverine; D000527:Alprostadil; D010646:Phentolamine