ABSTRACT
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.
Subject(s)
Erectile Dysfunction , Penile Erection , Spinal Cord Injuries/complications , Adrenergic alpha-Antagonists/administration & dosage , Adrenergic alpha-Antagonists/economics , Adult , Aged , Alprostadil/administration & dosage , Alprostadil/economics , Cost-Benefit Analysis , Drug Costs , Erectile Dysfunction/economics , Erectile Dysfunction/etiology , Erectile Dysfunction/therapy , Female , Humans , Male , Middle Aged , Papaverine/administration & dosage , Papaverine/economics , Penile Erection/physiology , Penile Prosthesis/economics , Phentolamine/administration & dosage , Phentolamine/economics , Piperazines/administration & dosage , Piperazines/economics , Purines , Quality of Life , Sexual Partners , Sildenafil Citrate , Socioeconomic Factors , Spinal Cord Injuries/economics , Spinal Cord Injuries/physiopathology , Sulfones , Surveys and Questionnaires , Vasodilator Agents/administration & dosage , Vasodilator Agents/economicsABSTRACT
Lise Lanctôt, who has a master's degree in nursing and a diploma from the high-ranking Ecole nationale d'administration, is the executive director of the Montreal AIDS Support Committee (its French initials are CSAM). This private organization focuses on advocacy and community health, offers services to people with AIDS or AIDS-related illnesses, those who test HIV-positive, as well as their family and friends. Believing that prevention is the cornerstone in the fight against AIDS, Lanctôt calls for a coordinated effort in this area, best achieved through a strong network of individuals and organizations.
