Patient Preference and Adherence (Sep 2023)
Health-Care Resource Utilization and Treatment Patterns in Men with Erectile Dysfunction and Benign Prostatic Hyperplasia-Associated Lower Urinary Tract Symptoms in the United States: A Retrospective Database Study
Abstract
Irwin Goldstein,1 Tarek Hassan,2 Kelly Zou,3 Victoria Divino,4 Mitch DeKoven,4 Joseph Imperato,3 Vamshi Ruthwik Anupindi,4 Jim Li3 1Department of Sexual Medicine, Alvarado Hospital, San Diego, CA, USA; 2Department of Urology, Viatris Inc, Canonsburg, PA, USA; 3Global Medical Analytics and Real World Evidence, Viatris Inc, Canonsburg, PA, USA; 4Health Economics/Outcomes Research and Real-World Insights, IQVIA, Falls Church, VA, USACorrespondence: Tarek Hassan, Global Medical Lead, Department of Urology, Global Medical and Clinical, Viatris Inc, 1000 Mylan Blvd, Canonsburg, PA, 15317, USA, Tel +1 3474432850, Email [email protected]: To compare health-care resource utilization (HCRU) outcomes in patients with erectile dysfunction (ED) and benign prostatic hyperplasia-associated lower urinary tract symptoms (BPH-LUTS) treated with tadalafil or non-phosphodiesterase-5 inhibitor (PDE5i), adherence to and persistence with tadalafil by dose in the United States (US).Methods: This was a noninterventional, real-world evidence study of men (aged ≥ 45 years) with ED and BPH-LUTS treated with tadalafil or non-PDE5i. The IQVIA US PharMetrics Plus claims database was used. Outcomes included all-cause and disease-specific HCRU over a 12-month follow-up. Persistence with and adherence to tadalafil were evaluated stratified by dose (10 or 20 mg as needed; 2.5 or 5 mg as once daily [OD]).Results: The final sample comprised 11,351 tadalafil and 48,722 non-PDE5i patients. For all-cause and disease-specific HCRU, including prescription fills, physician office visits, emergency room visits, laboratory tests, radiology examinations, outpatient surgical services, ancillary services, hospitalizations, mean number of utilizations, and proportions of patients with one or more utilizations, were lower for tadalafil compared with non-PDE5i patients. For all-cause HCRU, proportions of patients with one or more emergency room visits (18.6% vs 21.7%, p< 0.0001) and outpatient surgical visits (63.0% vs 68.8%, p< 0.0001) were significantly lower for tadalafil compared with non-PDE5i patients. For disease-specific HCRU, the proportion with one or more disease-specific physician office visits (55.1% vs 91.4%), laboratory tests (34.8% vs 58.2%), outpatient surgery (24.3% vs 38.9%), or outpatient ancillary services (18.0% vs 29.8%) were significantly lower for tadalafil compared with non-PDE5i patients (all comparisons, p< 0.0001). Mean persistence days (179.8 vs 61.2), proportion persistence (35.8% vs 6.5%), and mean adherence (0.5 vs 0.2) were higher for tadalafil OD doses than as-needed tadalafil doses.Conclusion: Patients on tadalafil demonstrated less HCRU and higher persistence and adherence (OD versus as-needed tadalafil) than non-PDE5i patients, which demonstrates its benefit in the management of ED and BPH-LUTS in the US.Plain Language Summary: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) conditions are more common in adult men and increase with age. These conditions affect their sexual satisfaction, create mental stress, and impact their interactions with family and associates. This study examined the patterns of health-care resource utilization (HCRU) in 11,351 patients treated with tadalafil versus 48,722 not treated with any PDE5i and compared treatment adherence to and persistence with tadalafil in patients with ED and comorbid BPH-LUTS in the US. All-cause and disease-specific HCRU were lower in patients treated with tadalafil than patients not treated with any PDE5i. The persistence with and adherence to therapy was higher with once-daily dose of tadalafil (2.5 or 5 mg) compared with as-needed dose of tadalafil (10 or 20 mg). Therefore, a lower dose of tadalafil demonstrated benefit in the management of men with ED and BPH-LUTS.Keywords: medication adherence, persistence, phosphodiesterase-5 inhibitor, real-world evidence, tadalafil
