Ellen Cahill, MD, on PDE-5 inhibitor prescription patterns

In this video, Ellen Cahill, MD, discusses the background and notable findings from the study “Trends in Phosphodiesterase Type 5 Inhibitor Prescriptions and Cost: Medicare Analysis 2017-2021,” which she presented at the 2024 Sexual Medicine Society of North American Fall Scientific Meeting in Scottsdale, Arizona. Cahill is a urology resident at Yale School of Medicine in New Haven, Connecticut.

Transcription:

Please provide an overview of this study and its notable findings.

For the PDE-5 inhibitor study, patients are being treated with PDE-5 inhibitors very regularly for erectile dysfunction. It's really the first-line treatment. Patients can present either to urology or to their primary care doctors for erectile dysfunction. What's interesting is we have different medications. They are associated with different costs, different ways of taking the medication, different dosages. It's kind of nuanced, actually, more than you would think. I was interested in knowing what the practice patterns were over the past few years; what is being prescribed for erectile dysfunction, and what's the difference between a urologist and a nonurologist who's prescribing these medications. I was also interested in looking at the costs associated with these drugs, because over time, they have become more and more affordable, and how that impacts which one is being prescribed and how often. That was our main goal. In order to do this, we did a Medicare Part D analysis of all of the PDE-5 inhibitors from 2017 to 2021. We specifically looked at the number of claims for sildenafil, tadalafil, and vardenafil. Then we looked at who were they prescribed by—urologists vs nonurologists—and the total annual expenditures, both for each drug and overall.

What we found is that costs have really dramatically decreased year by year for all 3 medications. Costs are really declining from $400 million each year coming down. In terms of claims, they have increased overall each year as well. Increasing claims, decreasing costs, which is great. Urologists and nonurologists did have differences in terms of what they're prescribing. Nonurologists are much more likely to prescribe sildenafil than tadalafil. Urologists are more likely to prescribe tadalafil. However, interestingly, over the 5-year period, tadalafil decreased from a urology perspective in prescriptions, but is still higher, whereas sildenafil rose. They almost are converging, it seems like, by 2021, which I thought was interesting.

Overall, our take-homes were that these medications are becoming more affordable, which is great, and I think because of that, the prescription patterns have increased. More and more providers are able to prescribe them. But there are different nuances in who's prescribing what, which I think is also interesting.

This transcript was AI generated and edited by human editors.