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Current stepwise recommendations for hypogonadism screening in erectile dysfunction are not cost-effective.

Afonso Morgado1,2, Maria Leonor Moura3, Paulo Dinis4,5

  • 1Serviço de Urologia, Centro Hospitalar Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal. luisafonsomorgado@gmail.com.

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Screening for hypogonadism in men with erectile dysfunction (ED) using a stepwise approach, starting with total testosterone (TT), incurs higher costs and more procedures. An initial full hormonal assessment may be more cost-effective for this patient group.

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Area of Science:

  • Endocrinology
  • Urology
  • Health Economics

Background:

  • Hypogonadism frequently co-occurs with erectile dysfunction (ED).
  • Current guidelines suggest screening for hypogonadism using total testosterone (TT) levels.
  • Further hormonal assessments (LH, SHBG, albumin) are recommended if TT is low to determine etiology and guide treatment.

Purpose of the Study:

  • To evaluate the cost-effectiveness of the current stepwise screening approach for hypogonadism versus an initial comprehensive hormonal assessment in male patients with ED.
  • To analyze direct healthcare costs associated with each screening strategy.

Main Methods:

  • A prospective study included 81 male patients referred for ED, screened for hypogonadism.
  • Patients underwent a stepwise assessment: initial TT measurement, followed by full hormonal assessment (TT, LH, SHBG, albumin for free testosterone) if TT was below 345 ng/mL.
  • Direct costs were calculated based on national healthcare system reimbursement rates.

Main Results:

  • 34.6% of patients required a full hormonal assessment after initial TT screening.
  • The stepwise approach resulted in an average direct cost increase of €5.82 per patient compared to an initial full assessment.
  • Approximately one in three patients needed two additional venipunctures and a follow-up appointment.

Conclusions:

  • The current stepwise screening protocol for hypogonadism in patients with ED may be less cost-effective than an initial full hormonal assessment, especially in populations with high hypogonadism prevalence.
  • The increased costs and patient burden associated with the stepwise method warrant re-evaluation for the ED subpopulation.