Abstract
Hypogonadism is a prevalent comorbidity with erectile disfunction (ED) and current guidelines recommend screening for hypogonadism with total testosterone (TT). If low TT is detected, further assessment with LH and SHBG plus albumin are needed to establish an etiology and treatment. Our primary objective was to determine the cost benefit of current stepwise approach versus ad initium full hormonal assessment. Two hundred consecutive male patients referred for ED were screened after consent and 81 were included and assessed for hypogonadism according to the current stepwise approach with TT, and only if TT was less than 345 ng/mL, a full hormonal assessment with TT, LH, and SHBG plus albumin to calculate free testosterone was performed. Direct costs were calculated using the national public healthcare system reimbursement tables and were compared with a hypothetical initial full hormonal assessment. Screening TT was less than 345 ng/mL in 34.6% patients leading to a full hormonal assessment on these. Using a stepwise approach there was a direct cost increase of 5.82 € per patient. Moreover, one out of every three patients had two extra venipunctures and an additional follow-up appointment. Current stepwise recommendations may prove costly in high prevalence scenarios such as the ED subpopulation as a direct cost increase was observed.
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References
Araujo AB, Esche GR, Kupelian V, O'Donnell AB, Travison TG, Williams RE, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92:4241–7.
Tajar A, Huhtaniemi IT, O'Neill TW, Finn JD, Pye SR, Lee DM, et al. Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS). J Clin Endocrinol Metab. 2012;97:1508–16.
Corona G, Maggi M. The role of testosterone in erectile dysfunction. Nat Rev Urol. 2010;7:46–56.
Corona G, Isidori AM, Aversa A, Burnett AL, Maggi M. Endocrinologic control of men's sexual desire and arousal/erection. J Sex Med. 2016;13:317–37.
Corona G, Sforza A, Maggi M. Testosterone replacement therapy: long-term safety and efficacy. World J Mens Health. 2017;35:65–76.
Dean JD, McMahon CG, Guay AT, Morgentaler A, Althof SE, Becher EF, et al. The International Society for Sexual Medicine's Process of Care for the assessment and management of testosterone deficiency in adult men. J Sex Med. 2015;12:1660–86.
Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metabol. 2018;103:1715–44.
Mulhall J, Trost L, Brannigan R, Kurtz E, Redmon J, Chiles K, et al. Evaluation and Management of Testosterone Deficiency. 2018. https://www.auanet.org/guidelines/testosterone-deficiency-(2018)#x7647.
Hatzimouratidis K, Giuliano F, Moncada I, Muneer A, Salonia A, Verze P. Male sexual dysfunction. In EAU guidelines. EAU Guidelines Office: Arnhem, The Netherlands; 2018.
Chamnan P, Simmons RK, Khaw KT, Wareham NJ, Griffin SJ. Estimating the potential population impact of stepwise screening strategies for identifying and treating individuals at high risk of type 2 diabetes: a modelling study. Diabet Med. 2012;29:893–904.
Maseroli E, Corona G, Rastrelli G, Lotti F, Cipriani S, Forti G, et al. Prevalence of endocrine and metabolic disorders in subjects with erectile dysfunction: a comparative study. J Sex Med. 2015;12:956–65.
Mushtaq S, Khan K, Abid S, Umer A, Raza T. Frequency of hypogonadism and erectile dysfunction in type-II diabetic patients. Cureus. 2018;10:e2654.
Portaria nº207/2017, Diário da República n.º 132/2017, 2º Suplemento, Série I de 2017-07-11, Ministério da Saúde, 2017. https://dre.pt/home/-/dre/107677706/details/maximized. https://dre.pt/application/conteudo/107669157.
Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84:3666–72.
Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med. 2012;29:855–62.
Kvamme MK, Lie E, Kvien TK, Kristiansen IS. Two-year direct and indirect costs for patients with inflammatory rheumatic joint diseases: data from real-life follow-up of patients in the NOR-DMARD registry. Rheumatol. 2012;51:1618–27.
Tajima-Pozo K, de Castro Oller MJ, Lewczuk A, Montanes-Rada F. Understanding the direct and indirect costs of patients with schizophrenia. F1000Res. 2015;4:182.
Jannini EA, Isidori AM, Aversa A, Lenzi A, Althof SE. Which is first? The controversial issue of precedence in the treatment of male sexual dysfunctions. J Sex Med. 2013;10:2359–69.
Wang C, Cunningham G, Dobs A, Iranmanesh A, Matsumoto AM, Snyder PJ, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab. 2004;89:2085–98.
Zitzmann M, Mattern A, Hanisch J, Gooren L, Jones H, Maggi M. IPASS: a study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men. J Sex Med. 2013;10:579–88.
Corona G, Maseroli E, Rastrelli G, Sforza A, Forti G, Mannucci E, et al. Characteristics of compensated hypogonadism in patients with sexual dysfunction. J Sex Med. 2014;11:1823–34.
Ventimiglia E, Ippolito S, Capogrosso P, Pederzoli F, Cazzaniga W, Boeri L, et al. Primary, secondary and compensated hypogonadism: a novel risk stratification for infertile men. Andrology. 2017;5:505–10.
Huang YP, Liu W, Chen SF, Liu YD, Chen B, Deng CH, et al. Free testosterone correlated with erectile dysfunction severity among young men with normal total testosterone. Int J Impot Res, 2014;31:132–8.
Kohler TS, Kim J, Feia K, Bodie J, Johnson N, Makhlouf A, et al. Prevalence of androgen deficiency in men with erectile dysfunction. Urology. 2008;71:693–7.
Corona G, Mannucci E, Petrone L, Ricca V, Balercia G, Mansani R, et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res. 2006;18:190–7.
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Morgado, A., Moura, M.L., Dinis, P. et al. Current stepwise recommendations for hypogonadism screening in erectile dysfunction are not cost-effective. Int J Impot Res 32, 297–301 (2020). https://doi.org/10.1038/s41443-019-0169-0
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DOI: https://doi.org/10.1038/s41443-019-0169-0
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