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Organo Oficial de la Sociedad Mexicana de Urología

2008, Number 1

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Rev Mex Urol 2008; 68 (1)

Saving by sildenafil administration as co-adjuvant in the adhesion to pharmacologic treatment in hypertension

Arreola-Ornelas H, García-Mollinedo L, Rosado BA, Mould-Quevedo J, Dávila-Loaiza G

Language: Spanish
References: 67
Page: 21-35
PDF size: 403.15 Kb.


ABSTRACT

Objective: To estimate net savings and cost effectiveness obtained through the use of 50-100 mg/oral of Sildenafil for Erectile Dysfunction (ED) as an auxiliary in pharmacological treatment adherence in patients with Hypertension and Type 2 Diabetes versus ED treatment options: non-treatment, 10-20 mg/oral Vardenafil and 20 mg/oral Tadalafil, in the Instituto Mexicano de Seguro Social (Mexican Social Security Institute) (IMSS).
Methods: With a decision tree model, a random, retrospective sample of 1,000 hypertensive patients and 1,000 diabetic patients, all presenting with ED, was created from a total of 13,731 IMSS patients hospitalized for hypertension and 65,523 for diabetes in 2005 (SUI-13 IMSS national database) to determine resource use. The study effectiveness measures were ED treatment success, reduced treatment abandonment rate for hypertension and diabetes, respectively, and avoided hospital stay (for diabetes, hypertension and respective chronic complications). These measures were estimated through analysis of the scientific literature on the subject and through prospective research with an instrument developed ex profeso and applied by telephone to a representative Mexico City population of 326 hypertensive patients and 146 diabetic patients. The study horizon was 5 years with projections at 5 and 10 years after treatment initiation, from the perspective of the public health service provider (IMSS) as well as from a social perspective. ED pharmacological management was carried out with 50-100 mg/oral of Sildenafil and compared with the options of non-treatment, treatment with 20 mg/oral of Tadalafil and 10–20 mg/oral of Vardenafil. Results were expressed in US dollars from the year 2006. Sensitivity analysis for each base pathology was carried out individually, starting from cost modifications per patient, effectiveness rates and frequency of chronic complications.
Results: A 50mg dose of Sildenafil was the treatment alternative with the lowest annual cost: in DM 2,609.11 – 2,932.23 USD (CI 95%; P = 0.0001), and in SAH 2,812.13 – 3,032.69 USD (CI 95%; P = 0.0001) and represented a cost-saving ED therapy versus non-treatment. In DM, a year of ED treatment with 50mg of Sildenafil versus ED non-treatment option produced a savings of 753.13 – 829.94 USD (CI 95%; P = 0.0001); 3,213.02 – 3,624.21 USD (CI 95%; P = 0.0000) at 5 years of treatment; and 12,070.08 – 13,301.39 USD (CI 95%; P = 0.0001) at 10 years of treatment. In SAH, a year of ED treatment with 50mg of Sildenafil versus ED non-treatment option produced a savings of 1,540.54 – 1,667.10 USD (CI 95%; P = 0001); 5,475.72 – 7,190.28 USD (CI 95%; P = 0.0000) at 5 years; and 24,325.00 – 26,741.22 USD (CI 95%; P = 0.0001) at 10 years. In relation to effectiveness, 14 DM and SAH patients with ED avoided hospitalization (CI 95%) when treated with 50mg of Sildenafil, while 18 DM and SAH patients with ED avoided hospitalization (CI 95%) when treated with 100mg of Sildenafil.
100mg of Sildenafil was the alternative with greater incremental effectiveness (4 avoided hospitalization days vs 50mg of Sildenafil, which was the second best alternative and the least expensive in both base pathologies), and the best CEA for DM (0.13 - 0.36 USD CI 95%; P = 0.0001) as well as for SAH (1.07 – 1.89 USD CI 95%; P = 0.0001) and superior to the other ED treatment alternatives.
Conclusions: The results show Sidenafil to be cost-saving vs ED non-treatment and have superior cost-effectiveness vs 20mg of Taladafil and 10-20mg of Vardenafil in hypertensive and diabetic patients.


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