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Erectile dysfunction management after failed phosphodiesterase-5-inhibitor trial: a cost-effectiveness analysis

  
@article{TAU24756,
	author = {Rachel A. Moses and Ross E. Anderson and Jaewhan Kim and Sorena Keihani and James R. Craig and Jeremy B. Myers and Sara M. Lenherr and William O. Brant and James M. Hotaling},
	title = {Erectile dysfunction management after failed  phosphodiesterase-5-inhibitor trial: a cost-effectiveness analysis},
	journal = {Translational Andrology and Urology},
	volume = {8},
	number = {4},
	year = {2019},
	keywords = {},
	abstract = {Background: To evaluate the cost-effectiveness of alternate erectile dysfunction (ED) management options after failed first line phosphodiesterase-5-inhibitors (PDE5-I).
Methods: An empiric, repetitive decision tree analysis model was constructed using literature review and expert clinical judgement. This assessed the expected costs and quality adjusted life years (QALYs) of decision alternatives over a 10-year period. The model incorporated interventions including alternate PDE5-Is, intracorporal injections (ICI) with alprostadil or trimix (alprostadil, phentolamine, and papaverine), and inflatable penile prosthesis placement (IPP) and included respective risks of failure, subsequent interventions, and other complications (including priapism risk). Average model QALY estimates obtained from the literature were as follows: ED =0.56, successful alternate PDE5-I =0.70, successful ICI =0.70, and successful IPP =0.78. Cost data were calculated from a high-volume academic center and published manufacturer data.  
Results: Over the 10-year period, IPP placement was the most cost-effective management option per preserved QALY (QALY =7.82, cost =\$22,009/10 years) as compared to ICI alprostadil (QALY =8.51, cost =\$62,890/10 years), ICI trimix (QALY =8.47, cost =\$48,617/10 years) and alternate PDE5-I (QALY =7.73, \$52,883/10 years).
Conclusions: Using expert opinion and published utility, cost, and complication data in a decision analysis, we demonstrated that IPP placement is the most cost-effective ED intervention following failed initial PDE5-I over a 10-year period as compared to alternate treatment options. Such cost-effectiveness outcomes may be used in ED management counseling.},
	issn = {2223-4691},	url = {http://tau.amegroups.com/article/view/24756}
}