Cost utility analysis of sildenafil compared with papaverine-phentolamine injections

doi:10.1136/bmj.320.7243.1165

BMJ 2000;320:1165 ( 29 April )

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Cost utility analysis of sildenafil compared with papaverine-phentolamine injections

Elly A Stolk, research fellow, ^a Jan J V Busschbach, senior researcher, ^a Max Caffa, urologist, ^b Eric J H Meuleman, urologist, ^c Frans F H Rutten, professor. ^a

^a Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands, ^b Department of Urology, Hospital St Antoniushove, Leidschendam, Netherlands, ^c Department of Urology, University Medical Centre St Radboud, Nijmegen, Netherlands

Correspondence to: E A Stolk stolk{at}bmg.eur.nl

Objective: To compare the cost effectiveness of sildenafiland papaverine-phentolamine injections for treating erectiledysfunction.
Design: Cost utility analysis comparing treatmentwith sildenafil (allowing a switch to injection therapy) and treatmentwith papaverine-phentolamine (no switch allowed). Costs and effectswere estimated from the societal perspective. Using time trade-off,a sample of the general public (n=169) valued health states relatingto erectile dysfunction. These values were used to estimated healthrelated quality of life by converting the clinical outcomes ofa trial into quality adjusted life years(QALYs).
Participants: 169 residents ofRotterdam.
Main outcome measures: Cost per quality adjusted lifeyear.
Results: Participants thought that erectile dysfunctionlimits quality of life considerably: the mean utility gain attributableto sildenafil is 0.11. Overall, treatment with sildenafil gainedmore QALYs, but the total costs were higher. The incremental costeffectiveness ratio for the introduction of sildenafil was £3639in the first year and fell in following years. Doubling the frequencyof use of sildenafil almost doubled the cost per additionalQALY.
Conclusions: Treatment with sildenafil is cost effective.When considering funding sildenafil, healthcare systems shouldtake into account that the frequency of use affects costeffectiveness.

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