University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, USA.
University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, USA.
J Sex Med. 2022 Nov;19(11):1608-1615. doi: 10.1016/j.jsxm.2022.03.609. Epub 2022 Jun 9.
Direct-to-consumer telemedicine platforms have expanded their reach to include services for the evaluation and treatment of testosterone deficiency.
We aim to (i) evaluate the treatment practices and costs associated with receiving testosterone therapy through direct-to-consumer telemedicine platforms; (ii) compare these practices to the American Urological Association guidelines; and (iii) compare the cost of receiving similar care at a tertiary center.
Google was queried to identify telemedicine platforms offing testosterone therapy. Websites were analyzed for information regarding the initial consultation, initial laboratory evaluation, follow up, treatment monitoring regimen, and associated costs of receiving testosterone therapy. The costs for similar services at a tertiary care center were estimated using a single institution's online cost estimator for a patient with no insurance, private insurance, or Medicare.
Evaluation and treatment practices of each platform were compared to the American Urological Association guidelines, and a cost analysis was completed for the cost of (i) undergoing an initial evaluation, and (ii) receiving 12 months of treatment through each platform and at a tertiary center.
Three online platforms met inclusion criteria: Hone, Regenex Health, and TRT Nation. The initial evaluation and follow up of patients on TTh were similar between the online platforms and practice guidelines. The costs of the initial consultation were lowest for the patient with Medicare at a tertiary center and via the telemedicine platforms. Conversely, the cost of 12 months of intramuscular testosterone treatment was highest via the telemedicine platforms, ranging from $1,586 to $4,200, as compared to the tertiary center, which ranged from $134.01 to $1,333.04 with varying insurance models. Costs of ongoing treatment with transdermal testosterone are similarly higher via DTC platforms.
Patients with private insurance or Medicare should be counseled that ongoing treatment through telemedicine platforms will likely incur a greater cost than receiving such care at a tertiary center that can utilize insurance coverage.
STRENGTHS & LIMITATIONS: Practice and cost comparisons include accurate, up-to-date information based on each platform's website. Limitations include the analysis of only three telemedicine platforms, and the ability to describe only the information provided on each website. In addition, cost estimates for the tertiary center only include a single type of private and public insurance, limiting generalizability.
This observational study indicates that direct-to-consumer telemedicine platforms are largely following practice guidelines in the evaluation and treatment of testosterone, however, there is a high cost associated with ongoing treatment. Jesse E, Sellke N, Rivero M-J, et al. Practice Comparison and Cost Analysis of Direct-to-Consumer Telemedicine Platforms Offering Testosterone Therapy. J Sex Med 2022;19:1608-1615.
直接面向消费者的远程医疗平台已经扩大了其服务范围，包括评估和治疗睾丸激素缺乏症的服务。
我们旨在：（i）评估通过直接面向消费者的远程医疗平台接受睾丸激素治疗的治疗实践和相关成本；（ii）将这些实践与美国泌尿外科学会指南进行比较；（iii）比较在三级中心接受类似护理的成本。
谷歌搜索确定提供睾丸激素治疗的远程医疗平台。分析网站，获取有关初始咨询、初始实验室评估、随访、治疗监测方案以及接受睾丸激素治疗相关费用的信息。使用单一机构的在线成本估算器估算了在三级护理中心接受类似服务的费用，该成本估算器适用于没有保险、私人保险或医疗保险的患者。
三家在线平台符合纳入标准：Hone、Regenex Health 和 TRT Nation。在线平台和实践指南之间的 TTh 患者初始评估和随访相似。在三级中心和远程医疗平台，接受 Medicare 的患者初始咨询费用最低。相反，12 个月的肌肉内睾丸激素治疗费用通过远程医疗平台最高，范围从 1586 美元到 4200 美元不等，而三级中心的费用则因不同的保险模式而有所不同，范围从 134.01 美元到 1333.04 美元不等。通过 DTC 平台进行的透皮睾丸激素治疗的持续治疗费用也同样较高。
有私人保险或医疗保险的患者应被告知，通过远程医疗平台进行持续治疗的费用可能高于在可利用保险的三级中心接受此类护理的费用。
实践和成本比较包括基于每个平台网站的准确、最新信息。局限性包括仅分析了三个远程医疗平台，以及只能描述每个网站提供的信息。此外，三级中心的成本估算仅包括单一类型的私人和公共保险，限制了通用性。
这项观察性研究表明，直接面向消费者的远程医疗平台在评估和治疗睾丸激素方面在很大程度上遵循实践指南，但持续治疗的费用很高。Jesse E、Sellke N、Rivero M-J 等人。直接面向消费者的远程医疗平台提供睾丸激素治疗的实践比较和成本分析。J 性别医学 2022；19:1608-1615.
