(322) PATIENT OUT-OF-POCKET COSTS FOR GUIDELINE-RECOMMENDED TREATMENTS FOR ERECTILE DYSFUNCTION: A MEDICARE COST MODELING ANALYSIS

Abstract Introduction Patient out-of-pocket (OOP) cost represents a barrier to accessing treatment for erectile dysfunction (ED). Many physicians have limited insight into the costs and insurance coverage of the treatment options that they recommend. Objective We sought to evaluate OOP costs incurred by men with ED covered by Fee-for-Service Medicare. Methods The 2018 American Urological Association (AUA) guidelines were used to identify recommended ED treatments. Coverage policies were obtained from the Medicare Coverage Database. OOP costs were retrieved from the 2023 CMS Final Rule. For treatments not covered by Medicare, OOP costs were extracted from GoodRx® or published literature and inflated to 2022 dollars. Annual prescription costs were calculated using a published estimate of 52.2 instances of sexual intercourse per year. The estimated number of Medicare patients with ED (n = 254,650) was used to evaluate healthcare system implications. Results Medicare has established coverage for inflatable penile prostheses (IPP; strong recommendation), non-coverage for vacuum erection devices (VED; moderate recommendation) and phosphodiesterase type-5 inhibitors (PDE5i; strong recommendation), and no existing policies for intracavernosal injections (ICI; moderate recommendation), intraurethral alprostadil (IA; conditional recommendation), or extracorporeal shock wave therapy (ESWT; conditional/investigational recommendation; Table 1). Annual IA prescription is associated with the highest patient OOP cost ($4,022), followed by annual ICI prescription ($3,947), one ESWT treatment course ($3,445), IPP ($1,600; inpatient deductible), annual PDE5i prescription ($696), and one VED ($213; Fig. 1). Among PDE5i, avanafil is associated with the highest annual OOP cost ($3,455), followed by vardenafil ($2,102), tadalafil ($723), and sildenafil ($459). One-year projections demonstrate IA is associated with the highest national healthcare OOP cost ($1.02 billion), followed by ICI ($1.0 billion), ESWT ($877 million), IPP ($407 million), PDE5i ($177 million), and VED ($54 million). Conclusions PDE5i and IPP are cost-effective options with strong guideline recommendations. Better understanding of patient financial burden may improve shared decision making with patients who suffer from ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.