Kenneth J. Smith, MD; Mark S. Roberts, MD, MPP
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Current Author Addresses: Dr. Smith: Department of Medicine, Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15219.
Dr. Roberts: Center for Research on Health Care, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213.
Author Contributions: Conception and design: K.J. Smith, M.S. Roberts.
Analysis and interpretation of the data: K.J. Smith, M.S. Roberts.
Drafting of the article: K.J. Smith.
Critical revision of the article for important intellectual content: K.J. Smith, M.S. Roberts.
Final approval of the article: K.J. Smith, M.S. Roberts.
Collection and assembly of data: K.J. Smith.
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.
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.
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Smith KJ, Roberts MS. The Cost-Effectiveness of Sildenafil. Ann Intern Med. 2000;132:933–937. doi: 10.7326/0003-4819-132-12-200006200-00002
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Published: Ann Intern Med. 2000;132(12):933-937.
Healthcare Delivery and Policy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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