Insurers Should Cover Post-Op ED Treatment

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ORLANDO—Men who experience erectile dysfunction (ED) following prostate cancer surgery usually do not have coverage for ED treatment even though their insurance policies cover surgery for prostate cancer, according to a study.

 

The impact of ED on self-esteem and body image to prostate cancer patients can be as detrimental as the loss of a breast can be to a woman, argue investigators in the department of urology at the New York University School of Medicine.

 

The Women's Health and Cancer Rights Act, passed by Congress in 1998, requires that third-party payers who cover mastectomy for breast cancer also cover the costs of breast reconstruction. No such comparable legislation is in effect for ED following radical prostatectomy.

 

“The time for legislative parity in this area has come,” said co-investigator Elias Hyams, MD, a resident physician. “The economic cost of breast reconstruction following mastectomy, appropriately covered by third-party payers per federal mandate, exceeds the potential economic burden of covering erectile dysfunction therapy after radical prostatectomy. Actual utilization of ED benefits would likely be lower, as not all men seek treatment.”

 

Approximately 60,000 radical prostatectomies and 60,000 breast reconstruction surgeries are performed each year in the United States. Researchers used this patient population to determine health-care costs for ED therapy over a projected 10-year life expectancy. On average, the costs of treating ED were significantly less than the costs of breast construction, according to the investigators.

 

Over a 10-year period, it would cost an estimated $345 million for sildenafil treatments and $54 million each for intracavernosal injections and intraurethral alprostadil therapy, the investigators found. Penile implants were estimated to cost $720 million over 10 years, the same as the actual annual cost for breast reconstruction.

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