The relationship between Erectile Dysfunction (ED) and cardiovascular disease (CVD) has been well known to the medical community for some time. In fact, the onset of ED can predict future myocardial infarct, years before symptoms begin. The Princeton III consensus recommended several years ago that men presenting with ED be screened for CVD risk, but the cost efficacy of such intervention had not been determined.
When we set out on the work culminating in this paper, we were attempting to model the potential value of screening solely for ED using many methods, from labs to duplex Doppler ultrasonography, in efforts to identify both ED and CVD early in their course. However, we were limited by existing evidence supporting such interventions, particularly in the setting of screening, and importantly, such an all-inclusive approach was prohibitively expensive. We then found that rather than focusing on catching ED early in every man, it would be simpler and more effective to catch CVD in men presenting with ED. Good data exist indicating that nearly half of men CVD risk factors such as hypertension, high cholesterol, or diabetes are undiagnosed and untreated for those conditions.
Considering that men with ED, which is obvious and has a clear detrimental effect on the man, may be more likely to go to a doctor than those with conditions that lack immediate ramifications, using ED as an opportunity to screen men for other conditions presented a golden opportunity. Using available data relating CVD and ED coincidence and known rates of undiagnosed CVD, we modeled the number of men with hypertension, diabetes or high cholesterol that could be diagnosed when presenting for ED. Applying demonstrated rates of acute CVD event risk reduction using standard oral medications, we calculated that over 20 years, up to 1.1 million cardiovascular events could be avoided by identifying and treating these men. Avoiding these events would save $23.1 billion in acute medical costs over that time period alone, not even considering savings afforded by continued productivity of the men. Importantly, the screening costs totaling $2.7 billion were only a fraction of the costs saved, resulting in a net savings of over $20 billion.
We feel that our model demonstrates a practical and effective means to apply the relationship between CVD and ED. By simply ensuring that men who present with ED are screened for CVD risk factors, we stand to do well by our patients and society.
Written by:
Daniel A. Hyman, MD
Baylor College of Medicine
Houston, TX
Alexander W. Pastuszak, MD, PhD
Division of Male Reproductive Medicine and Surgery
Scott Department of Urology
Baylor College of Medicine
Houston, TX