Current stepwise recommendations for hypogonadism screening in erectile dysfunction are not cost-effective.,International Journal of Impotence Research

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Current stepwise recommendations for hypogonadism screening in erectile dysfunction are not cost-effective.
International Journal of Impotence Research ( IF 2.8 ) Pub Date : 2019-06-26 , DOI: 10.1038/s41443-019-0169-0
Afonso Morgado _{1,

2} , Maria Leonor Moura ₃ , Paulo Dinis _{1,

4} , Carlos Martins Silva _{1,

4}

Affiliation

Hypogonadism is a prevalent comorbidity with erectile disfunction (ED) and current guidelines recommend screening for hypogonadism with total testosterone (TT). If low TT is detected, further assessment with LH and SHBG plus albumin are needed to establish an etiology and treatment. Our primary objective was to determine the cost benefit of current stepwise approach versus ad initium full hormonal assessment. Two hundred consecutive male patients referred for ED were screened after consent and 81 were included and assessed for hypogonadism according to the current stepwise approach with TT, and only if TT was less than 345 ng/mL, a full hormonal assessment with TT, LH, and SHBG plus albumin to calculate free testosterone was performed. Direct costs were calculated using the national public healthcare system reimbursement tables and were compared with a hypothetical initial full hormonal assessment. Screening TT was less than 345 ng/mL in 34.6% patients leading to a full hormonal assessment on these. Using a stepwise approach there was a direct cost increase of 5.82 € per patient. Moreover, one out of every three patients had two extra venipunctures and an additional follow-up appointment. Current stepwise recommendations may prove costly in high prevalence scenarios such as the ED subpopulation as a direct cost increase was observed.

中文翻译：

目前对勃起功能障碍性腺功能减退筛查的逐步建议并不划算。

性腺功能减退是合并勃起功能障碍（ED）的普遍合并症，目前的指南建议用总睾丸激素（TT）筛查性腺功能减退。如果检测到较低的TT，则需要进一步用LH和SHBG加上白蛋白进行评估，以确定病因和治疗方法。我们的主要目标是确定当前逐步方法相对于initium完整荷尔蒙评估的成本收益。同意后筛查连续200例接受ED的男性患者，并纳入81名患者，并根据目前的TT分步方法评估性腺功能减退，并且只有当TT小于345 ng / mL时，才应使用TT，LH进行全面的激素评估，用SHBG加白蛋白计算游离睾丸激素。使用国家公共卫生保健系统的报销表计算直接费用，并将其与假设的初始完整荷尔蒙评估进行比较。对34.6％的患者进行的TT筛查少于345 ng / mL，从而对这些激素进行了全面的荷尔蒙评估。采用逐步方法，每位患者的直接成本增加了5.82欧元。此外，每三名患者中就有一名接受了两次额外的静脉穿刺，并进行了额外的随访。当前的逐步建议可能会在高患病率的情况下（例如ED亚人群）证明是昂贵的，因为观察到直接成本增加。每三名患者中就有一名进行了两次额外的静脉穿刺，并进行了额外的随访。当前的逐步建议可能会在高患病率的情况下（例如ED亚人群）证明是昂贵的，因为观察到直接成本增加。每三名患者中就有一名进行了两次额外的静脉穿刺，并进行了额外的随访。当前的逐步建议可能会在高患病率的情况下（例如ED亚人群）证明是昂贵的，因为观察到直接成本增加。

更新日期：2019-11-18

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