Temporal Trends in Intracavernosal Injection Therapy and Penile Prosthesis Implantation in the Era of Phosphodiesterase-5 Inhibitors for Erectile Dysfunction in Australia
Abstract
Introduction: Phosphodiesterase-5 inhibitors (PDE5-Is) transformed erectile dysfunction (ED) management as first-line therapy; nonetheless, many patients require second- and third-line options due to inadequate response, side effects, or contraindications. This article evaluates temporal trends in intracavernosal injection (ICI) therapy and penile prosthesis implantation (PPI) in Australia since PDE5-Is introduction.
Methods: MBS item numbers 37415 (ICI), and 37429/37426 (PPI) from 1998 to 2024 were analysed. Data were stratified by age and state, standardised to Australian male population estimates, and reported per 100 000 men. Compound annual growth rates (CAGR) were calculated with break points at major events (release of PDE5-Is, generics, COVID-19). RPBS data were extracted for eligible PDE5-Is and alprostadil from 1998 to 2024. Government expenditure was included and trends compared with international cohorts.
Results: Across 260 756 procedures (17 882 PPI; 242 874 ICI), PPI sharply declined in 1996-1999 (CAGR -16.02%/year) after sildenafil introduction but demonstrated sustained growth over time (+7.08%/year 2000-2009 and +4.73%/year 2010-2020). Growth slowed to +1.94%/year 2020-2024 with COVID-related elective surgery disruptions. ICI use collapsed after 1998, stabilised in the 2010s, and contracted further during COVID, equating to a 97% reduction (CAGR -11.4%/year). PPI shifted toward older men aged 55-84 with marked increase in those aged 65-74 and 75-84 years,…
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