Erectile dysfunction: 75% with diagnosis go untreated



SAN DIEGO – Of men given an ICD-9 diagnosis of erectile dysfunction, 25% receive any treatment for the condition.

Treatment frequency was higher in men who had low levels of testosterone (51% treated) and lower in those who had prostate cancer (15% treated). Treatment frequency did not vary significantly with other associated comorbidities, Dr. Brian T. Helfand said in a press briefing at the annual meeting of the American Urological Association.

Dr. Helfand of the department of urology at NorthShore University Health System in Evanston, Ill., and his associates used an IMS data set to identify 6,228,509 men over the age of 30 years who received an ICD-9 diagnosis of erectile dysfunction (ED) during a 12-month period that ended in July 2011. IMS is a large insurance claims data set that encompasses more than 80% of prescription data in the United States.

Men were classified as treated if they filled a prescription for a phosphodiesterase type-5 (PDE5) inhibitor, injection or urethral prostaglandins, or androgen replacement therapy. They were classified as untreated if they received an ED diagnosis but did not fill a prescription in the study period. The researchers monitored the therapies by prescription frequency, age, comorbidities, and physician specialty.

Among the 25% of men who filled prescriptions, PDE5 was the most commonly prescribed medication (75%), followed by androgen replacement therapy (31%). Fewer than 2% of patients used any prostaglandin therapy. "The men who were in the oldest age groups were the least likely to fill a prescription," Dr. Helfand said.

Dr. Brian T. Helfand

The greatest proportion of prescriptions overall were ordered by primary care physicians (28%), followed by endocrinologists (27%), and urologists (21%). The remaining 24% were ordered by various other clinicians.

Dr. Helfand said limitations of the study include the exclusion of Medicare data plus lack of information about the severity of ED, efficacy of treatments, and adherence to long-term therapy.

Dr. Ajay Nangia, who is an associate professor of urology at the University of Kansas Medical Center and the moderator of the press briefing, noted that ED is a medical disease that is often a portent of other disorders. Recognizing that men with ED go untreated may mean that they’re also possibly underinvestigated for associated condition such as diabetes, lipid disorders, and risk factors such as smoking.

Dr. Helfand said that he had no relevant financial conflicts to disclose. One of the study authors, Dr. Kevin McVary, disclosed consultant, advisory, or other roles with several companies, including Allergan, Lilly, NxThera, Watson, NeoTract, and GSK.

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