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

• 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
• ISSN: 1650-1977
• DOI: 10.1080/16501970510038365

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.