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.