An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide.

A lack of uniformity exists for insurance payer coverage for all categories of penile prostheses (PP). We sought to determine common insurance coverage criteria and barriers to implantation across common insurance plans from healthcare referral regions (HRR) nationwide. Coverage criteria and stipulations were reviewed regarding erectile dysfunction (ED) etiology, ED duration, contributing comorbid conditions, medications, drug use, diagnostic tests, use of procedures and prior interventions. Seventy of 100 plans included coverage criteria. 36.1% provided coverage only in cases of gender dysphoria. 27.7% required documentation of trial, contraindication or intolerance to pharmacologic therapy, with varying descriptors of what this entailed. 13.8% required at least consideration of prior pharmacologic therapy. 4.2% required trial or contraindication to classic second-line therapies. 25.0% stated that ED must be organic. Psychogenic ED was covered by 12.5% of plans. Eleven plans required at least 6 or 12 months of symptoms. Laboratory evaluation to rule out hypogonadism or hyperprolactinemia was required by five plans. Insurance coverage criteria for PP placement were highly variable by state and plan. Coverage is provided for PP implantation in most cases for ED of organic etiology following failure of pharmacologic therapy when contributing comorbidities are optimally managed.

Regional Variation in Penile Prosthesis Utilization among Medicare Patients with Erectile Dysfunction.

OBJECTIVE: To characterize penile prosthesis surgery utilization and assess for regional differences in the use of this procedure across the United States. MATERIALS & METHODS: We examined penile prosthesis surgeries (inflatable and semirigid implants) in Medicare beneficiaries with erectile dysfunction (ED) for the years 2006 through 2014. Adjusted utilization rates were calculated per 1000 beneficiaries accounting for age and race. Utilization rates were examined nationally and by hospital referral region (HRR). RESULTS: The national adjusted rate of penile prosthesis surgery declined from 5.41 per 1000 beneficiaries in 2006 to 3.74 per 1000 beneficiaries in 2014. The number of beneficiaries diagnosed with ED outpaced the number of patients undergoing surgery. Regional variation was observed; a 12-fold difference in 2014 (1.9/1000 in Norfolk, VA to 24.2/1000 in Miami, FL). Adjustment of 2014 data by urology provider density reduced variation between HRRs, and as a result a 3.5-fold difference was observed. Over 60% of HRRs performed 0 to <11 surgeries. CONCLUSION: The rate of penile prosthesis surgery is declining amongst Medicare beneficiaries with ED. Significant regional variation exists in the utilization of penile prosthesis surgery. This variation may be explained by a series of urologist and patient-specific factors, including provider density. Penile prosthesis surgery in Medicare beneficiaries is likely highly dependent on where these patients seek care.

A Review of Economic Evaluations of Erectile Dysfunction Therapies.

INTRODUCTION: Erectile dysfunction (ED) is a common and costly urologic condition with increasing prevalence as men age. Cost-effectiveness of ED therapies and whether cost-effectiveness varies for different populations of men remains underexplored. AIM: To review and summarize available published data on the economic evaluation of ED therapies and to identify gaps in the literature that still need to be addressed. METHODS: All relevant peer-reviewed publications and conference abstracts were reviewed and incorporated. RESULTS: There are a number of medical and surgical treatment options available for ED. The economic evaluation of phosphodiesterase-5 inhibitors, particularly sildenafil, has been well described. However, minimal research has been conducted to assess the cost-effectiveness of intracavernosal injections, intraurethral suppositories, penile prosthesis surgery, vacuum erection devices, and other emerging therapies in men with different causes of ED. CONCLUSION: Available economic evaluations of ED therapies are dated, do not reflect present-day physician, pharmaceutical, and device costs, fail to account for patient comorbidities, and may not be generalizable to today's ED patients. Substantial research is needed to evaluate the cost-effectiveness of ED treatments across different patient populations, countries, and reimbursement systems. Rezaee ME, Ward CE, Brandes ER, et al. A Review of Economic Evaluations of Erectile Dysfunction Therapies. Sex Med Rev 2019;8:497-503.