title: Undertreatment of erectile dysfunction: claims analysis of 6.2 million patients.
abstract: BACKGROUND
  Prior research conducted on treatment of erectile dysfunction (ED) has been derived from surveys involving relatively small populations of men. There are needs for large population-based studies in this area. Our study addresses that need.
  
  
  OBJECTIVE
  The aim of this study was to characterize ED treatment among a large population of men.
  
  
  METHODS
  Patients ≥30 years in commercial insurance dataset with diagnosis code for ED during 12-month period ending June 2011 were identified. Men were considered "treated" if prescription was filled for phosphodiesterase type 5 inhibitor (PDE5i), injection or urethral prostaglandins, or androgen replacement (ART) during study period. "Untreated" patients received the diagnosis but did not fill prescription. Statistical analyses were used to compare prescription frequency with clinical characteristics, including age and comorbidities.
  
  
  METHODS
  ED treatment rates among large population of insured men, treatment types employed, patient demographics, associated medical comorbidities of this population, and prescriber details were the main outcome measures.
  
  
  RESULTS
  Only 25.4% of 6,228,509 men with ED were treated during study period. While PDE5is were the most commonly prescribed medical therapy (75.2%), ART was utilized as monotherapy or in combination therapy in 30.6% of men. ART was significantly (P < 0.0001) more frequently used in men <40 and >65 years. Although ED frequency was associated with increased age and number of comorbidities, men >60 years were significantly (P < 0.0001) less likely to be treated compared with men aged 40-59 years. Additionally, treatment frequency did not vary as a function of number of comorbidities. However, compared with men with prostate cancer, men with comorbid hypogonadism, sleep disorders, benign prostatic hyperplasia, or components of metabolic syndrome were (P < 0.0001) more likely to be treated.
  
  
  CONCLUSIONS
  Despite high prevalence of ED with age and comorbidities, most men continue receiving no treatment. Although benefits of medical intervention for ED are well-recognized, many barriers to treatment continually exist including physician, patient and partner preference and knowledge.
authors: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors: Luke R
authors: LR
authors: Frederick
authors: Omer Onur
authors: OO
authors: Cakir
authors: Hans
authors: H
authors: Arora
authors: Brian T
authors: BT
authors: Helfand
authors: Kevin T
authors: KT
authors: McVary
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D015995:Prevalence; D011470:Prostatic Hyperplasia / Q000188:drug therapy / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D058986:Phosphodiesterase 5 Inhibitors
keywords: Comorbidity; Erectile Dysfunction; Hypogonadism; Medical Intervention of Erectile Dysfunction; Phosphodiesterase 5 Inhibitors; Treatment