Abstract
With recent innovative developments in microsurgery, novel, safe, and effective surgical options for erectile dysfunction (ED) are quickly emerging which may replace mainstay medical treatments. In an age where health care is increasingly focused on financial accountability and clinical outcomes, cost-utility analysis between nonsurgical treatment (pharmaceutical agents, mechanical devices, and shockwave therapy) and emerging surgical options will prove relevant and impactful to all physicians that treat patients with ED. The purpose of this study was to use the cost-utility analysis to compare the costs, outcomes, and overall quality of life conveyed to the patient by either nonsurgical or surgical treatments for ED. These results will help patients and physicians form more informed decisions when it comes to the treatment of men suffering from ED. The cost-utility analysis makes use of costs, probabilities, and utilities of health outcomes (referred to as health states) that are used to evaluate opposing interventions. Amazon Mechanical Turk© was used to derive utility scores for health states associated with surgical and nonsurgical interventions. In addition, a systematic review was performed to identify common complications of treatment and associated probabilities. All direct costs were derived from national Medicare facility reimbursement data and national hospital billing charges for fiscal year 2017, and indirect costs were accounted for by our utility estimates. Baseline analysis revealed an incremental cost-utility ratio of $(1428.00) in favor of surgical intervention. The cost of lifetime medical therapy was $15,488.28 greater than that of surgery even when adjusted for inflation. Furthermore, surgery provided patients with a quality-adjusted life-year gain of 10.77 years greater than medical treatment. Long-term costs and utility data should be taken into consideration when determining the best treatment options for a patient with ED. Surgical interventions for erectile dysfunctions represent a significant cost savings to society compared with nonsurgical treatment. Phosphodiesterase type-5 (PDE5) inhibitors offered the greatest cost with the least clinical benefit in the eyes of the patient. Level of evidence: Not ratable.
Published Version
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