The cost effectiveness of sildenafil remains controversial, due in part to questions about the magnitude and significance of changes in quality-of-life utility values as a result of its use. Our objective was to measure utilities for present health and hypothetical erectile function scenarios in men with and without erectile dysfunction (ED) and to measure utilities in men with ED before and after treatment with sildenafil. SUBJECTS AND M ethods: Men with and without ED were recruited from a urologist's office. Subjects completed the International Index of Erectile Function (IIEF), the 12-Item Short-Form health survey (SF-12), and utility assessments (visual analogue scale [VAS], time tradeoff [TTO], and standard gamble [SG]) for their own present health and erectile function as well as for hypothetical scenarios of poor and very good erectile function. Exclusion criteria were cardiac illness history, current nitrate use, present sildenafil use, or inability to follow up.
Eighty-nine men without ED and 58 men with ED were recruited. Fifteen men with ED (25.9%) were prescribed sildenafil and completed at least one follow-up interview. Utilities for men with ED were significantly lower than men without ED by VAS (0.71 vs 0.84, p < 0.01) and TTO (0.89 vs 0.96, p < 0.01), but not by SG. Men without ED rated the poor erectile function scenario lower than men with ED; both groups rated the very good erectile function scenario similarly. Men without ED rated poor erectile function significantly lower than their present health (utility differences 0.34 for VAS, 0.08 for TTO and SG). In 15 men who gave ratings after sildenafil, significant changes were seen in IIEF scores, but not in utilities.
Men with ED had lower VAS and TTO utilities than men without ED. Based on utility differences between present health and a poor erectile function scenario in men without ED, sildenafil would likely be considered cost effective from a societal perspective. However, sildenafil therapy may be less cost effective from a patient perspective, but conclusions are limited by the small group of men providing ratings after sildenafil therapy. Very good erectile function is highly valued by men regardless of their erectile function status.