Contemporary cost-analysis comparison of direct-to-consumer vs. traditional prescriptions of phosphodiesterase-5 inhibitors

A contemporary review of the treatments and challenges associated with penile rehabilitation after radical prostatectomy including a proposed optimal approach

Prostate cancer is one of the most prevalent malignancies affecting men worldwide. Despite advancements in understanding prostate anatomy and minimally invasive approaches to surgical treatment, surgery can have significant adverse effects on sexual function. Penile rehabilitation strategies have emerged as a promising approach to mitigate the impact of prostate cancer treatments on erectile function and improve quality of life. Several methods have been employed for penile rehabilitation, including pharmacotherapy, vacuum erection devices, intracavernous injections, and emerging novel techniques. Yet, there is no consensus on the exact programs or timing of initiation that should be utilized for optimal recovery after surgery. This review discusses various rehabilitation protocols and long-term outcomes and explores the cost-effectiveness of different interventions. Additionally, this review discusses the importance of a multidisciplinary approach to penile rehabilitation which includes patient education, counseling, and the selection of an appropriate rehabilitation strategy tailored to each individual's needs and preferences. Continued research and collaboration among healthcare professionals are essential to refine rehabilitation approaches and ensure optimal outcomes for patients with prostate cancer.

Characteristics of direct-to-consumer platforms offering erectile dysfunction treatment

Background

Due to the sensitivity and potential embarrassment of discussing erectile dysfunction (ED) in person, men are seeking treatment online.

Aims

We sought to compare offerings of direct-to-consumer (DTC) platforms for ED treatment with respect to consultation, pricing, services, and privacy policy.

Methods

Google was queried to identify DTC platforms offering ED treatment with the keywords: "telehealth erectile dysfunction," "telemedicine erectile dysfunction," and "online erectile dysfunction." Inclusion criteria were as follows: serving a majority of U.S. states, existing online only, providing both the consultation and prescription for phosphodiesterase type 5 inhibitors, and delivering the prescription to the patient.

Results

Fifteen DTC platforms met criteria. Ten provided free consultations; 4 bundled the consultation fee with the first month of the prescription, with 1 of these functioning as a subscription service. Fourteen (93%) relied on online intake forms and 10 (67%) advertised review by the prescriber within 2 business days. Only 4 (27%) platforms explicitly advertised physician-only consults. Direct contact with the prescriber would only occur if needed or if required by state law at 8 (53%) platforms. Purchasing sildenafil and tadalafil was advertised on all platforms. Minimum prices of sildenafil ranged from $0.50 to $35/pill (mean $5.16/pill, median $2.65/pill); tadalafil ranged from $0.50 to $9.80/pill (mean $4.70/pill, median $3.21/pill). In addition to ED therapy, 13 (86%) platforms offered treatment for other men's health issues. All platforms included a website privacy policy, but only 10 (67%) mentioned Health Insurance Portability and Accountability Act compliance, with 2 of these claiming to not be covered entities.

Conclusion

Although DTC platforms are transparent with phosphodiesterase type 5 inhibitor medication and subscription pricing information, few offer direct contact with a physician to further discuss issues related to ED after completion of the online intake form. For comprehensive evaluation of ED in Health Insurance Portability and Accountability Act-compliant settings, in-person or telemedicine visits should be arranged with men's physicians.

Exploring the relationship between socioeconomic status and erectile dysfunction: an analysis of the National Health and Nutrition Examination Survey

The aim of this study was to investigate the association between socioeconomic status and erectile dysfunction. Data were obtained from the National Health and Nutrition Examination Survey, a nationally representative survey of the United States population. Socioeconomic status was estimated using the poverty income ratio, a ratio of family income to established poverty levels. Erectile function was assessed from a single survey question and was divided into two groups: normal (always and usually able to maintain an erection) and erectile dysfunction (sometimes or never able to maintain an erection). Multivariable logistic regression, using a multi-model approach, was used to characterize the interplay between well-established risk factors for erectile dysfunction and socioeconomic status. Our final cohort included 3679 respondents, representative of 81,255,155 subjects with a mean age of 44.4 [SE, 0.365]. Multivariable logistic regression showed that low-income respondents were significantly more likely to report erectile dysfunction [adjusted odds ratio (AOR) = 1.95, 95% CI 1.28-2.96; p = 0.003] compared to higher-income respondents. This study suggests that low socioeconomic status may be associated with erectile dysfunction in a large, nationally representative sample.