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Erectile dysfunction in spinal cord injury: a cost-utility analysis.

Mittmann N, Craven BC, Gordon M, MacMillan DH, Hassouna M, Raynard W, Kaiser A, Lanctôt LK, Tarride JE

Department of Pharmacology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue E240, Toronto, Ontario M4N 3M5, Canada. nicole.mittmann@sw.ca

BACKGROUND: There is a high incidence of erectile dysfunction after spinal cord injury. This can have a profound effect on quality of life. Treatment options for erectile dysfunction include sildenafil, intracavernous injections of papaverine/alprostadil (Caverject), alprostadil/papaverine/phentolamine ("Triple Mix"), transurethral suppository (MUSE), surgically implanted prosthetic device and vacuum erection devices. However, physical impairments and accessibility may preclude patient self-utilization of non-oral treatments. METHODS: The costs and utilities of oral and non-oral erectile dysfunction treatments in a spinal cord injury population were examined in a cost-utility analysis conducted from a government payer perspective. Subjects with spinal cord injury (n=59) reported health preferences using the standard gamble technique. RESULTS: There was a higher health preference for oral therapy. The cost-effectiveness results indicated that sildenafil was the dominant economic strategy when compared with surgically implanted prosthetic devices, MUSE(R) and Caverject. The incremental cost-utility ratios comparing sildenafil with triple mix and vacuum erection devices favoured sildenafil, with ratios less than CAN$20,000 per quality adjusted life year gained. CONCLUSION: Based on this study, we conclude that sildenafil is a cost-effective treatment for erectile dysfunction in the spinal cord injury population.

Published 18 November 2005 in J Rehabil Med, 37(6): 358-64.
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