Erectile dysfunction in spinal cord injury: a cost-utility analysis

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 ("T...

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Bibliographic Details
Published in:	Journal of rehabilitation medicine Vol. 37; no. 6; pp. 358 - 364
Main Authors:	Mittmann, Nicole, Craven, B Catherine, Gordon, Michael, MacMillan, D H Robert, Hassouna, Magdy, Raynard, Warren, Kaiser, Anita, Lanctôt, L Krista, Tarride, Jean-Eric
Format:	Journal Article
Language:	English
Published:	Sweden 01-11-2005
Subjects:	Adrenergic alpha-Antagonists - administration & dosage Adrenergic alpha-Antagonists - economics Adult Aged Alprostadil - administration & dosage Alprostadil - economics Cost analysis Cost benefit analysis Drug Costs Erectile dysfunction Erectile Dysfunction - economics Erectile Dysfunction - etiology Erectile Dysfunction - therapy Female Humans Male Medical treatment Middle Aged Papaverine - administration & dosage Papaverine - economics Penile Erection - physiology Penile Prosthesis - economics Phentolamine - administration & dosage Phentolamine - economics Piperazines - administration & dosage Piperazines - economics Purines Quality of Life Sexual Partners Sildenafil Sildenafil Citrate Socioeconomic Factors Spinal cord injured people Spinal cord injuries Spinal Cord Injuries - complications Spinal Cord Injuries - economics Spinal Cord Injuries - physiopathology Sulfones Surveys and Questionnaires Treatment Utility Vasodilator Agents - administration & dosage Vasodilator Agents - economics
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Summary:	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. 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. 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. Based on this study, we conclude that sildenafil is a cost-effective treatment for erectile dysfunction in the spinal cord injury population.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1650-1977
DOI:	10.1080/16501970510038365