The Cost-Effectiveness of Sildenafil

20 June 2000 | Volume 132 Issue 12 | Pages 933-937

Background: Coverage of sildenafil by health insurance plans is a contentious issue.

Objective: To evaluate the cost-effectiveness of sildenafil treatment for erectile dysfunction.

Design: A Markov decision model to estimate the incremental cost-effectiveness of sildenafil compared with no drug therapy.

Data Sources: Values for the efficacy and safety of sildenafil and quality-of-life utilities were obtained from the published medical literature. Base-case values were chosen to bias against sildenafil use.

Target Population: Men 60 years of age with erectile dysfunction.

Time Horizon: Lifetime.

Perspective: Societal and third-party payer.

Intervention: Sildenafil or no treatment in identical hypothetical cohorts.

Outcome Measures: Cost per quality-adjusted life-year (QALY) gained.

Results of Base-Case Analysis: The cost per QALY gained for sildenafil treatment compared with no therapy was $11 290 from the societal perspective and $11 230 from the third-party payer perspective.

Results of Sensitivity Analysis: From the societal perspective, the cost per QALY gained associated with sildenafil was less than $50 000 if treatment-related morbidity was less than 0.8% per year, mortality was less than 0.55% per year, treatment was successful in more than 40.2% of patients, or sildenafil cost less than $244 per month. The results were sensitive to variation of erectile dysfunction utilities, but cost per QALY gained was less than $50 000 if successful treatment increased utility values by 0.05 or more on a scale of 0 (death) to 1 (perfect health).

Conclusions: In an analysis biased against use of sildenafil, the cost-effectiveness of sildenafil treatment compared favorably with that of accepted therapies for other medical conditions.

Author and Article Information

From Mercy Hospital of Pittsburgh and the Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Requests for Single Reprints: Kenneth J. Smith, MD, Department of Medicine, Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15219; e-mail, ksmith{at}pmhs.mercy.org.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Current Author Addresses: Dr. Smith: Department of Medicine, Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15219.

Dr. Roberts: Center for Research on Health Care, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213.

Author Contributions: Conception and design: K.J. Smith, M.S. Roberts.

Analysis and interpretation of the data: K.J. Smith, M.S. Roberts.

Drafting of the article: K.J. Smith.

Critical revision of the article for important intellectual content: K.J. Smith, M.S. Roberts.

Final approval of the article: K.J. Smith, M.S. Roberts.

Collection and assembly of data: K.J. Smith.