The Cost-Effectiveness of Sildenafil

Abstract

Coverage of sildenafil by health insurance plans is a contentious issue. To evaluate the cost-effectiveness of sildenafil treatment for erectile dysfunction. A Markov decision model to estimate the incremental cost-effectiveness of sildenafil compared with no drug therapy. 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. Men 60 years of age with erectile dysfunction. Lifetime. Societal and third-party payer. Sildenafil or no treatment in identical hypothetical cohorts. Cost per quality-adjusted life-year (QALY) gained. 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. 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). 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.