Erectile dysfunction as a marker for cardiovascular disease diagnosis and intervention: a cost analysis

Abstract

Introduction: Erectile dysfunction (ED) is a risk factor for cardiovascular disease (CVD). We examine the costs of screening men with ED for CVD risk factors and the cost savings of treating these at risk men.

Aim: This study aims to evaluate the effect of screening men presenting with ED for CVD risk factors and to determine the cost effectiveness of this screening protocol.

Methods: The known incidence and prevalence of ED and CVD, the rate of undiagnosed CVD, and the effects of CVD treatment were used to model the change in prevalence of acute CVD events and ED as a function of the number of men with ED and CVD. The cost savings associated with reduction in acute cardiovascular (CV) events and ED prevalence was estimated over 20 years.

Main outcome measures: Acute CVD event rate reduction and associated cost savings were modeled over 20 years.

Results: The relative risk of ED in men with CVD is 1.47 and the coprevalence of both ED and CVD was estimated at 1,991,520 men. Approximately 44% of men with CVD risk factors are unaware of their risk. If all men presenting with ED were screened for CVD, 5.8 million men with previously unknown CVD risk factors would be identified over 20 years, costing $2.7 billion to screen. Assuming a 20% decrease in CV events as a result of screening and treatment, 1.1 million cardiovascular events would be avoided, saving $21.3 billion over 20 years. Similarly, 1.1 million cases of ED would be treated, saving $9.7 billion. Together, the reduction in acute CVD and ED treatment cost would save $28.5 billion over 20 years.

Conclusions: Screening for CVD in men presenting with ED can be a cost-effective intervention for secondary prevention of both CVD and, over the longer term, ED.

Keywords: Cardiovascular Disease; Cardiovascular Disease Treatment; Cardiovascular Risk Factors; Cost Analysis; Erectile Dysfunction; Erectile Dysfunction Treatment.

Figure 1. Selection of Relevant Articles for Identification of ED and CVD Incidence and Prevalence

Flow chart depicting selection process of published articles containing ED and CVD prevalence and incidence data.

Figure 2. Undiagnosed CVD in Men with ED

Chart depicting the rise in incidences of ED alone and CVD in men with ED projected over 20 years.

Figure 3. Cost Savings Associated with Screening for CVD in Men with ED

Chart depicting annual cost savings associated with screening for CVD in men with ED extrapolated over 20 years. The gray line estimates the number of CVD events avoided per year. The filled gray regions represent cost savings associated with screening men with ED for CVD and subsequent treatment, either as a function of ED or CVD. Cumulatively, over 1.1 million CV events are avoided with a cumulative savings of over $28.5 billion. Annual screening costs are also indicated and represent a small fraction of the total cost savings.