Legislation Needed to Provide Coverage for ED Treatment after Prostatectomy

Newswise — Men who have developed erectile dysfunction (ED) following surgery for prostate cancer usually do not have insurance coverage for ED treatment even though their insurance policies cover surgery for prostate cancer, according to an analysis presented today at the 103rd Annual Scientific Meeting of the American Urological Association. In contrast, federal law requires that insurance companies which cover mastectomy for breast cancer treatment also cover breast reconstruction.

Erectile dysfunction (ED) is a common side effect of radical prostatectomy, though not always permanent, and almost all men experience some degree of ED following this surgery. 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. However, 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.

"There is compelling evidence that ED treatment leads to improved quality of life for the man and his partner," said Ira D. Sharlip, M.D., a spokesman for the AUA. Therefore, as in the case of breast reconstruction for women, the cost of ED treatment should most certainly be covered for men."

A number of treatments for ED are available, including oral pharmacotherapies (approximately $10 per pill), intracavernosal injections ($25 per treatment), intraurethral alprostadil ($25 per treatment), vacuum erection devices ($450) and penile implants ($12,000). On average, breast reconstruction surgeries cost $12,000 to $20,000.

Approximately 60,000 radical prostatectomies and breast reconstruction surgeries are performed each year. Researchers used this patient population to determine healthcare costs for ED therapy over a projected 10-year life expectancy and found that, on average, the costs to treat ED was significantly less than the cost of breast reconstruction. The authors conclude that the time for legislative gender parity in this area has come.

In addition to the author, Dr. Sharlip will be on hand to answer questions and provide third-party perspective on the study.

Hyams ES, Ficile MA, McCullough AR: The time for legislative gender parity has come: an economic argument for insurance reimbursement for erectile dysfunction therapy after radical prostatectomy. J Urol, suppl., 2008; 179: 58k, abstract 166.

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 15,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients, including UrologyHealth.org, an award-winning on-line patient education resource, and the American Urological Association Foundation, Inc.