title: Incremental cost-effectiveness of various monthly doses of vardenafil.
abstract: OBJECTIVE
  To compare the cost-effectiveness of four, six, and eight doses per month of vardenafil in the context of pharmacy benefit decision making.
  
  
  METHODS
  A Markov model was used to estimate the incremental cost-effectiveness of zero, four, six, or eight doses of vardenafil per month in hypothetical cohorts of 60-year-old male veterans with erectile dysfunction. Efficacy values for vardenafil were obtained from the literature, and vardenafil costs were obtained from Veterans Affairs pharmacy data. The analysis was conducted from a third-party payer perspective with a lifetime horizon, and the effect of parameter uncertainty was explored in one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  In the base case analysis, the cost per quality-adjusted life-year gained for four doses of vardenafil per month compared with no therapy was $576. Six doses per month compared with four cost $2585/quality-adjusted life-year gained, and eight doses per month compared with six cost $5169/quality-adjusted life-year gained. In one-way sensitivity analyses of six doses per month compared with four, variation of two parameters caused the incremental cost-effectiveness ratio to cross a willingness-to-pay threshold of $20,000: when the increased utility associated with giving two additional doses/month was less than 0.001 (baseline 0.01) and when the cost per dose increased to $15.00 (baseline $1.69).
  
  
  CONCLUSIONS
  Although four doses per month of vardenafil was the most cost-effective strategy, the use of six or eight doses per month also compares favorably with other accepted medical treatments. The results were stable across a range of inputs and help to support the current Veterans Affairs policy on the number of vardenafil doses provided per month for erectile dysfunction.
authors.affiliation: VA Center for Medication Safety, Hines, IL, USA. sherrie.aspinall@va.gov
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Aspinall
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Francesca E
authors.initials: FE
authors.lastname: Cunningham
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage / Q000191:economics*; D010879:Piperazines / Q000008:administration & dosage / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013450:Sulfones / Q000008:administration & dosage / Q000191:economics; D014227:Triazines / Q000008:administration & dosage / Q000191:economics; D000069058:Vardenafil Dihydrochloride; D014728:Veterans
chemical_list: D007093:Imidazoles; D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D013450:Sulfones; D014227:Triazines; D000069058:Vardenafil Dihydrochloride