3025 — Prevalence and Cost of Phosphodiesterase-5 Inhibitor Use in the VHA in 2004 and 2005
French DD (VISN-8 Patient Safety Center of Inquiry, James A. Haley Hospital, Tampa) , Margo CE
(The University of South Florida College of Medicine and Section of Ophthalmology, James A. Haley Hospital, Tampa), Campbell R
(VISN-8 Patient Safety Center of Inquiry, James A. Haley Hospital, Tampa)
Sildenafil (Viagra) was the only phosphodiesterase-5 inhibitor (PDE-5) drug on the market until vardenafil (Levitra) was approved by the U.S. Food and Drug Administration on August 19, 2003, and then tadalafil (Cialis) on November 21, 2003. We set out to determine the prevalence of PDE-5 within the VHA.
We extracted data from the decision support system pharmacy files and combined these with national patient care database for demographic and healthcare utilization.
Nearly 10.5% of the approximately 5.2 million male patients (age 18 years or older) treated in the VHA were dispensed a PDE-5; this ranged from only 0.41% for those less than 25 years of age to 16.5% for those between the ages of 55-59. We found that 2.1% of PDE-5 patients were 39 years of age or less, 74.0% were between the ages of 40 and 69 years, and 23.9% were 70 years or older. There were 12,984,875 tablets dispensed for 3,863,762 pharmacy claims, with a combined drug and dispensing cost of approximately $61.8 million, or $4.76 per tablet over two years (VHA annual pharmacy budget in 2005 of $5.4 billion). The average number of whole tablets per patient over the two years was 24 (range: 11 tablets for those less than 25 years to 25 tablets for those between the ages of 50-54). Also, 36.8% of all utilization involved men 65 years of age or older, while 23.9% were 70 years of age or older. The prevalence of PDE-5 use over the two-year study period was 105.2 patients per 1,000 male veterans aged 18 years or older.
When compared to utilization data from other health care systems, a greater proportion of men in the VHA are dispensed PDE-5 drugs. The reason for this is unclear, but is likely multifactorial. The large number of men over the age of 70 in the VHA taking PDE-5 raises concerns over safety, since this group is known to be at high risk from multiple drug interactions and have a high burden of chronic disease.
Clinicans should be aware of the potentially inappropriate prescribing of lifestyle medications with known risk or harms.