The cost-utility of Viagra® in The Netherlands

OBJECTIVE: Clinical trials suggest that sildenafil is an effective treatment for erectile dysfunction. Nevertheless, reimbursement is controversial: sildenafil is expected to be more effective than conservative therapy (papaverine/ phentolamine injections), but also more costly to society. Economic appraisal of sildenafil is of interest given the prevalence of the disorder. DESIGN: We analyzed the cost-effectiveness of a sildenafil scenario (allowing a switch to injection therapy) and the papaverine/ phentolamine scenario (conservative therapy, no switch allowed). Analyses were performed from the societal perspective. Values for health states of erectile dysfunction were collected using time trade-off. Using these values (N=169), we converted trial outcomes (Goldstein, 1998) into quality adjusted life years (QALYs). RESULTS: The mean utility gain attributable to sildenafil is 0.11. In the sildenafil scenario, more QALYs are gained but the total costs are higher. The incremental cost-effectiveness ratio of sildenafil is $6037 (£3639) in the 1st year, improving in following years. CONCLUSIONS: This cost-utility analysis suggests that the clinical effect of sildenafil are derived at reasonable costs. When considering reimbursement of sildenafil, it should be taken into account that the frequency of use affects this cost-effectiveness ratio.