Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Clin Drug Investig. 2005;25(2):99-105. doi: 10.2165/00044011-200525020-00002.
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.
西地那非的成本效益仍存在争议，部分原因是对其使用导致生活质量效用值变化的幅度和意义存在疑问。我们的目的是测量患有和不患有勃起功能障碍（ED）的男性的当前健康和假设的勃起功能情景的效用，并测量接受西地那非治疗前后 ED 男性的效用。
从泌尿科医生的办公室招募了患有和不患有 ED 的男性。受试者完成了国际勃起功能指数（IIEF）、12 项简短健康调查（SF-12）以及他们自己当前健康和勃起功能以及假设的勃起功能差和非常好的情景的效用评估（视觉模拟量表[VAS]、时间权衡[TO]和标准赌博[SG]）。排除标准包括心脏病病史、当前使用硝酸盐、当前使用西地那非或无法随访。
招募了 89 名无 ED 的男性和 58 名 ED 男性。15 名 ED 男性（25.9%）被开处西地那非，并完成了至少一次随访访谈。VAS（0.71 对 0.84，p<0.01）和 TTO（0.89 对 0.96，p<0.01）显示，ED 男性的效用明显低于无 ED 男性，但 SG 则不然。无 ED 的男性对较差的勃起功能情景的评价低于 ED 男性；两组对非常好的勃起功能情景的评价相似。无 ED 的男性对较差的勃起功能情景的评价明显低于他们的当前健康（VAS 的效用差异为 0.34，TTO 和 SG 为 0.08）。在 15 名接受西地那非治疗后进行评分的男性中，IIEF 评分发生了显著变化，但效用没有变化。
ED 男性的 VAS 和 TTO 效用低于无 ED 男性。基于无 ED 男性当前健康和较差勃起功能情景之间的效用差异，从社会角度来看，西地那非可能被认为具有成本效益。然而，从患者角度来看，西地那非治疗可能不太具有成本效益，但由于接受西地那非治疗后提供评分的男性人数较少，因此结论受到限制。无论其勃起功能状况如何，非常好的勃起功能都受到男性的高度重视。
