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. 2000 Jun 20;132(12):933-7.
doi: 10.7326/0003-4819-132-12-200006200-00002.

The cost-effectiveness of sildenafil

K J Smith  1 , M S Roberts
Affiliations

The cost-effectiveness of sildenafil

K J Smith et al. Ann Intern Med. .

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.

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Comment in

  • Tough choices: the cost-effectiveness of sildenafil.
    McGarvey MR. McGarvey MR. Ann Intern Med. 2000 Jun 20;132(12):994-5. doi: 10.7326/0003-4819-132-12-200006200-00011. Ann Intern Med. 2000. PMID: 10858184 No abstract available.
  • Cost-effectiveness of sildenafil.
    Beaird J. Beaird J. Ann Intern Med. 2001 Feb 6;134(3):249; author reply 250-1. doi: 10.7326/0003-4819-134-3-200102060-00018. Ann Intern Med. 2001. PMID: 11177340 No abstract available.
  • Cost-effectiveness of sildenafil.
    Groeneveld PW, Duncan BW. Groeneveld PW, et al. Ann Intern Med. 2001 Feb 6;134(3):249-50; author reply 250-1. doi: 10.7326/0003-4819-134-3-200102060-00019. Ann Intern Med. 2001. PMID: 11177341 No abstract available.
  • Cost-effectiveness of sildenafil.
    Siegel RL, Glasser DB. Siegel RL, et al. Ann Intern Med. 2001 Feb 6;134(3):250-1. doi: 10.7326/0003-4819-134-3-200102060-00020. Ann Intern Med. 2001. PMID: 11177342 No abstract available.

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