Undertreatment of Erectile Dysfunction: Claims Analysis of 6.2 Million Patients

• DOI: 10.1111/jsm.12647
• Publication Date: 2014-07-24T08:20:09Z
• Authors: Luke R. Frederick; Omer Onur Cakir; Hans Arora; Brian T. Helfand; Kevin T. McVary
• Keywords: Adult; Male; Prostatic Hyperplasia; Prostatic Neoplasms; Comorbidity; Middle Aged; Phosphodiesterase 5 Inhibitors; 3. Good health; Insurance Claim Review; 03 medical and health sciences; 0302 clinical medicine; Erectile Dysfunction; Prevalence; Humans; Aged

Abstract

Introduction Prior research conducted on treatment of erectile dysfunction (ED) has been derived from surveys involving relatively small populations of men. There are needs for large population-based studies in this area. Our study addresses that need.

Aim The aim of this study was to characterize ED treatment among a large population of men.

Methods Patients ≥30 years in commercial insurance dataset with diagnosis code for ED during 12-month period ending June 2011 were identified. Men were considered “treated” if prescription was filled for phosphodiesterase type 5 inhibitor (PDE5i), injection or urethral prostaglandins, or androgen replacement (ART) during study period. “Untreated” patients received the diagnosis but did not fill prescription. Statistical analyses were used to compare prescription frequency with clinical characteristics, including age and comorbidities.

Main Outcome Measures ED treatment rates among large population of insured men, treatment types employed, patient demographics, associated medical comorbidities of this population, and prescriber details were the main outcome measures.

Results Only 25.4% of 6,228,509 men with ED were treated during study period. While PDE5is were the most commonly prescribed medical therapy (75.2%), ART was utilized as monotherapy or in combination therapy in 30.6% of men. ART was significantly (P < 0.0001) more frequently used in men <40 and >65 years. Although ED frequency was associated with increased age and number of comorbidities, men >60 years were significantly (P < 0.0001) less likely to be treated compared with men aged 40–59 years. Additionally, treatment frequency did not vary as a function of number of comorbidities. However, compared with men with prostate cancer, men with comorbid hypogonadism, sleep disorders, benign prostatic hyperplasia, or components of metabolic syndrome were (P < 0.0001) more likely to be treated.

Conclusions Despite high prevalence of ED with age and comorbidities, most men continue receiving no treatment. Although benefits of medical intervention for ED are well-recognized, many barriers to treatment continually exist including physician, patient and partner preference and knowledge.