(322) patient OUT-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis
Abstract
Patient out-of-pocket (OOP) cost represents a barrier to accessing treatment for erectile dysfunction (ED). Many physicians have limited insight into the costs and insurance coverage of the treatment options that they recommend.
We sought to evaluate OOP costs incurred by men with ED covered by Fee-for-Service Medicare.
The 2018 American Urological Association (AUA) guidelines were used to identify recommended ED treatments. Coverage policies were obtained from the Medicare Coverage Database. OOP costs were retrieved from the 2023 CMS Final Rule. For treatments not covered by Medicare, OOP costs were extracted from GoodRx® or published literature and inflated to 2022 dollars. Annual prescription costs were calculated using a published estimate of 52.2 instances of sexual intercourse per year. The estimated number of Medicare patients with ED (n = 254,650) was used to evaluate healthcare system implications.
Medicare has established coverage for inflatable penile prostheses (IPP; strong recommendation), non-coverage for vacuum erection devices (VED; moderate recommendation) and phosphodiesterase type-5 inhibitors (PDE5i; strong recommendation), and no existing policies for intracavernosal injections (ICI; moderate recommendation), intraurethral alprostadil (IA; conditional recommendation), or extracorporeal shock wave therapy (ESWT; conditional/investigational recommendation; Table 1). Annual IA prescription is associated with the highest patient OOP cost ($4,022), followed…
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