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The Cost-Effectiveness of Sildenafil
- Kenneth J. Smith, MD; and
- Mark S. Roberts, MD, MPP
- From Mercy Hospital of Pittsburgh and the Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Abstract
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.
Article and Author Information
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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.
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Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
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Current Author Addresses: Dr. Smith: Department of Medicine, Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15219.
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Dr. Roberts: Center for Research on Health Care, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213.
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Author Contributions: Conception and design: K.J. Smith, M.S. Roberts.
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Analysis and interpretation of the data: K.J. Smith, M.S. Roberts.
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Drafting of the article: K.J. Smith.
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Critical revision of the article for important intellectual content: K.J. Smith, M.S. Roberts.
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Final approval of the article: K.J. Smith, M.S. Roberts.
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Collection and assembly of data: K.J. Smith.
- Copyright ©2004 by the American College of Physicians
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