A group of studies presented at the 2021 annual meeting of the American Urological Association illustrate the costs and risks of seeking care for men’s health issues online and / or from non-urologists.
The studies were presented at a press briefing hosted by Petar Bajic, MD, of the Center for Men’s Health at the Glickman Urological and Kidney Institute in Cleveland, Ohio.
Shock wave therapy
In the first study, James Weinberger, MD, MBA, reported on the results of a study evaluating shock wave therapy for erectile dysfunction in 7 major US cities.1
“Shockwave therapy has become restorative therapy for second-line erectile dysfunction referrals. The shockwave therapy market segment has been largely dominated by GAINSWAVE, a practitioner database and direct-to-consumer advertising platform that has promoted the effectiveness of shockwave therapy for dysfunction. erectile, despite limited evidence to support its claim, ”explained Weinberger, a urologist. resident at the David Geffen School of Medicine at the University of California, Los Angeles, working with Sriram Eleswarapu, MD, PhD, and colleagues.
For their study, the researchers used Google search to identify shockwave therapy providers in 7 major metropolitan areas (Atlanta, Georgia; Boston, Massachusetts; Dallas, Texas; Los Angeles, California; New York, New York; Philadelphia, Pennsylvania; and Washington DC). Search terms used included “Shock wave therapy for erectile dysfunction in [city],, “Shock wave therapy for erectile dysfunction in [city], “and” GAINSWAVE in [city]. “Clinics had to explicitly advertise shock wave therapy and be located within one of the metropolitan areas to be included in the analysis. Investigators obtained information over the phone, specifically inquiring about providers administering the treatment. as well as price and duration of treatment Clinics were excluded from the analysis after 3 unsuccessful contact attempts.
Sixty clinics that offered shock wave therapy for erectile dysfunction were identified, 60% of which offered full information on providers, prices and duration.
The average price was $ 3,559 per course of treatment (range $ 650 to $ 10,800). In the 7 metropolitan areas, an average of 10% of providers were trained in urology and 13% were non-physician providers.
“Level 1 data on shock wave therapy for ED is still pending. It should not be marketed as such. Above all, erectile dysfunction can portend significant morbidities. If patients are exploring second-line therapy, they should really be evaluated by [a] urologist, who can perform a formal assessment of men’s health, ”Weinberger said.
Prescription fees for PDEis
A second study sought to compare the costs of prescriptions for phosphodiesterase inhibitors (PDEi) when obtained from direct-to-consumer (DTC) online businesses versus a traditional doctor visit.2
For the study, investigators priced 90-day supplies of sildenafil (Viagra), 20 mg and 100 mg, and tadalafil (Cialis), 5 mg and 20 mg. Two DTC companies, 2 dispensing pharmacies, 3 Canadian pharmacies and 16 local US pharmacy chains in 5 zip codes were included in the analysis. Direct communication was used to obtain prices for DTC and the preparation and Canadian pharmacies, while local drugstore prices were obtained through GoodRx with an online coupon. The price of a doctor’s visit was determined based on the 2020 Centers for Medicare & Medicaid Services reimbursement.
“We found that visiting the doctor with a local drugstore prescription with the coupon consistently produced the lowest prices available. Selling direct to the consumer online has always provided the most expensive option for filling PDEi prescriptions. These effects were more pronounced at higher doses and with tadalafil compared to sildenafil, ”said first author Dennis Schneider, BS, a fourth year medical student at the University of California, Irvine, working with Faysal A. Yafi, MD, FRCSC, and colleagues.
The price difference between online DTP and a visit to the doctor at a local pharmacy was $ 54.55 for sildenafil 20 mg, $ 762.84 for sildenafil 100 mg, $ 594.20 for tadalafil 5 mg and $ 2719.00 for tadalafil 20 mg.
Male infertility supplements
In the third study presented at the briefing, investigators assessed supplements related to male infertility.3
Investigators surveyed online marketplaces Amazon, Google Shopping, and Walmart to find out what supplements are currently available for male infertility. They collected customer reviews and data regarding costs, ingredients, and advertised claims. They then compared the active ingredients to current literature from randomized controlled trials of supplements.
Investigators analyzed 30 separate supplements, of which a total of 73 ingredients were found. Zinc (57%), folic acid (53%), L-carnitine (50%) and selenium (50%) were the most commonly identified active ingredients.
“The majority of these ingredients – almost 60% of them – have not been studied in human trials. I thought it was one of our most important discoveries, ”said first author Igor Inoyatov, MD, resident in urology at the Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, in collaboration with Yefim R. Sheynkin, MD, FACS and colleagues.
What’s more, only zinc and vitamin E have been shown to improve fertility rates, Inoyatov said.
Analyzing the product claims, 70% claimed to improve sperm motility, 63% claimed to increase sperm count, and 12% claimed to increase the chances of conception. The 30-day average cost per product was $ 35.10.
“Although they are relatively cheaper than artificial reproduction technology, these ingredients are not supported by proven clinical efficacy,” said Inoyatov.
1. Weinberger J, Shahinyan R, Yang SC, et al. Trends in Marketing, Pricing AND Deployment of Erectile Dysfunction Shockwave Therapy in Major US Metropolises. Paper presented at the 2021 American Urological Association annual meeting. September 10-13; virtual. Summary MP36-13
2. Schneider D, El-Khatib F, Jenkins L, Yafi F. Contemporary cost analysis comparison between direct-to-consumer prescriptions and traditional prescriptions of PDE5 inhibitors. Paper presented at the 2021 American Urological Association annual meeting. September 10-13; virtual. Summary MP36-05
3. Inoyatov I, Mossack S, Hung M, et al. Male Infertility Supplements Online: A Growing Market Without Growing Evidence. Paper presented at the 2021 American Urological Association annual meeting. September 10-13; virtual. Summary MP31-18