The cost-effectiveness of sildenafil

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 corn pared 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.