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doi: 10.1080/16501970510038365
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® 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.Conclusion: Based on this study, we conclude that sildenafil is a cost-effective treatment for erectile dysfunction in the spinal cord injury population.
Nicole Mittmann A1, A2, B. Catherine Craven A3, Michael Gordon A4, D.H. Robert Macmillan A5, Magdy Hassouna A5, Warren Raynard A3, Anita Kaiser A3, L. Krista Lanctôt A2, A6, Jean-Eric Tarride A7
A1 Department of Pharmacology and Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario
A2 Health Outcomes and Pharmacoeconomic Research Centre, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario
A3 Toronto Rehabilitation Institute, Lyndhurst Centre, University of Toronto, Ontario
A4 Baycrest Centre for Geriatric Care, Mount Sinai Hospital, University of Toronto, Ontario
A5 Department of Surgery, University of Toronto, Ontario
A6 Departments of Psychiatry and Pharmacology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario
A7 At time of study, Outcomes Research, Pfizer Canada Inc. Kirkland, Quebec, since March 2005, Department of Cinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
erectile dysfunction, spinal cord injury, cost-utility analysis