Pharmacotherapy for Erectile Dysfunction Following Treatment for Prostate Cancer in the United States: Retention and Cost
Michaella M. Prasad, M.D.1, Sandip M. Prasad, M.D., M.Phil1, Aaron C. Weinberg, B.A.2, Xiangmei Gu, M.S.3, Nathanael D. Hevelone, M.P.H.3, Stuart R. Lipsitz, Sc.D.3, Ganesh S. Palapattu, M.D.4, Jim C. Hu, M.D., M.P.H.5.
1Harvard Longwood Program in Urology, Boston, MA, USA, 2Division of Urologic Surgery, Brigham and Women’s Hospital, Boston, MA, USA, 3Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA, 4Department of Urology, University of Rochester Medical Center, Rochester, NY, USA, 5Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
BACKGROUND: Erectile dysfunction (ED) after treatment for localized prostate cancer is often managed with various pharmacotherapies; however the utilization patterns, duration of therapy, and cost of treatment are unknown. Our aim is to ascertain utilization patterns among men who have trialed ED pharmacotherapies at least once after initial treatment for localized prostate cancer using a population-based approach.
METHODS: We identified 38,958 men from the MarketScan Medstat administrative dataset who underwent definitive treatment for localized prostate cancer during 2003-06 and selected the 7,258 patients that used any ED pharmacotherapy at least once after initial treatment. We assessed utilization and refill rates for pharmacotherapies at baseline (up to 3 months prior) and up to 30 months following surgery (RP), cryotherapy, or radiotherapy (RT) by identifying National Drug Classification codes for phosphodiesterase inhibitors (PDE5I), intracavernosal injectable therapies (IT), and urethral suppositories. The medication strength, duration of treatment, and refill patterns were captured and compared. We also estimated the annual costs associated with medical therapy for ED by treatment approach.
RESULTS: Men who used any ED therapy after definitive therapy for prostate cancer tended to be younger, with less comorbidity (p < 0.001), regardless of treatment approach. Most men utilized any ED pharmacotherapy for at least four months (p = 0.016). One-third of the men undergoing RP obtained no refills, one-third had 1-2 refills and the other third had 3+ refills (p < 0.001). In contrast, 40% of the men after RT and over half of the men post-cryotherapy obtained no refills (p < 0.001). Men more commonly trialed high vs. low dose of PDE5I and alprostadil IT across all RP and RT approaches (p < 0.001). The first year post-treatment median annual cost of ED is $184-236 after RP approaches, $177-211 after RT and $158 after cryotherapy (p < 0.001).
CONCLUSIONS: Men undergoing RP are more likely to obtain refills of their ED pharmacotherapy and incur higher costs compared to men undergoing RT or cyrotherapy.