Phosphodiesterase-5 inhibitors (PDE-5Is) are the first-line medical treatments for erectile dysfunction (ED), but are often restricted in public formularies. This study assesses PDE-5I usage among active-duty service members before and after the addition of sildenafil to the formulary of the Military Health System (MHS) in 2012. To assess, a cross-sectional evaluation was conducted, utilizing encounter and pharmaceutical claims data from the Military Health System Data Repository between 2010 and 2014. Separate zero-inflated, negative binomial models were used to assess changes in usage rates by prescription and by number of pills issued, for 37 947 patients. Increased PDE-5I usage was noted with select comorbidities, notably mental health and neurologic conditions. There was significant proportional variation in medication distribution following inclusion of sildenafil within the MHS formulary, with a minimal demographic impact on medication models. The average number of prescriptions decreased, while the quantity of distributed medications increased. A significant portion of PDE-5I recipients were young men, under 25 years old, who received medications on the first visit, which invites speculation about the effectiveness of treatment and appropriateness of use. Future studies aimed at evaluating prevalence in younger population may be of benefit.
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Armed Forces Health Surveillance Center (AFHSC). Erectile dysfunction among male active component service members, U.S. Armed Forces, 2004-2013. MSMR. 2014;21:13–6.
Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile dysfunction. Int J Impot Res. 2003;15:63–71.
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120:151–7.
Lowe G, Costabile RA. 10‐year analysis of adverse event reports to the Food and Drug Administration for phosphodiesterase type‐5 inhibitors. J Sex Med. 2012;9:265–70.
Nurnberg HG, Duttagupta S. Economic analysis of sildenafil citrate (Viagra) add-on to treat erectile dysfunction associated with selective serotonin reuptake inhibitor use. Am J Ther. 2004;11:9–12.
Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol. 2000;163:460–3.
Nall R, Gotter A. 5 common causes of impotence [Internet]. Healthline. 2016 [cited 14 Dec 2016]. http://www.healthline.com/health/erectile-dysfunction/common-causes-impotence#NeurologicalDisorders3
VA Pharmacy Benefits Management Services, Medical Advisory Panel, VISN Pharmacist Executives. Phosphodiesterase type 5 inhibitors for the treatment of BPH/LUTS and penile rehabilitation: evidence summary and recommendations [Internet]. Pharmacy Benefits Management Services; 2014. http://www.pbm.va.gov/PBM/clinicalguidance/clinicalrecommendations/PDE5I_BPH_LUTS_Evidence_Summary_and_Recommendations.pdf
Kime P. DoD spends $84M a year on Viagra, similar meds [Internet]. MilitaryTimes. 2015 [cited 14 Dec 2016]. http://www.militarytimes.com/story/military/benefits/health-care/2015/02/13/defense-department-troops-erectile-dysfunction/23350711/
Erectile dysfunction drugs market worth $3.2 billion by 2022 [Internet]. Grand View Research. 2016 [cited 14 Dec 2016]. https://www.grandviewresearch.com/press-release/global-erectile-dysfunction-drugs-market
Grand View Research. Erectile dysfunction drugs market size will be worth $3.2 billion by 2022: Grand View Research, Inc. [Internet]. GlobeNewswire News Room. 2015 [cited 14 Dec 2016]. http://globenewswire.com/news-release/2015/11/23/789503/0/en/Erectile-Dysfunction-Drugs-Market-Size-Will-Be-Worth-3-2-Billion-By-2022-Grand-View-Research-Inc.html
Military One Source. 2014 Demographics: profile of the military community. Office of the Deputy Assistant Secretary of Defense; Washington DC, 2014.
Shabsigh R, Shah M, Sand M. Erectile dysfunction and men’s health: developing a comorbidity risk calculator. J Sex Med. 2005;5:1237–43.
Laumann EO, West S, Glasser D, Carson C, Rosen R, Kang J. Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the male attitudes regarding sexual health survey. J Sex Med. 2011;4:57–65.
Hosain GMM, Latini DM, Kauth MR, Goltz HH, Helmer DA. Racial differences in sexual dysfunction among postdeployed Iraq and Afghanistan veterans. Am J Mens Health. 2013;7:374.
Akre C, Berchtold A, Gmel G, Suris J-C. The evolution of sexual dysfunction in young men aged 18–25 years. J Adolesc Health. 2014;55:736–43.
Godman H. Erectile dysfunction in young men: causes and treatments [Internet]. 2016 [cited 14 Dec 2016]. http://www.healthline.com/health/erectile-dysfunction/young-men#Overview1
Wilcox SL, Redmond S, Davis TL. Genital Image, Sexual Anxiety, and Erectile Dysfunction Among Young Male Military Personnel. J Sex Med. 2015;12:1389–97.
Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice. J Sex Med. 2013;10:1833–41.
Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces, Board on the Health of Select Populations, Institute of Medicine. Understanding substance use disorders in the military [Internet]. Washington, D.C.: National Academies Press; 2013 [cited 2016 Dec 21]. https://www.ncbi.nlm.nih.gov/books/NBK207276/
This research was funded by a grant from the United States Defense Health Agency, through the Henry M. Jackson Foundation for the Advancement of Military Medicine, for the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC).
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The authors declare that they have no conflict of interest.
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Montgomery, J., Madsen, C., Leroux, T. et al. Utilization and prescription patterns of phosphidiesterase-5 inhibitor medications in the United States military health system. Int J Impot Res 30, 300–305 (2018). https://doi.org/10.1038/s41443-018-0037-3
Editorial Comment on “Utilization and Prescription Patterns of Phosphidiesterase-5 Inhibitor Medications in the United States Military Health System”
International Journal of Impotence Research (2018)