(168) Financial Toxicity of Erectile Dysfunction: The First Assessment of the Economic Stress Associated With the Treatment of Erectile Dysfunction
Authors: Tawfik M , Zhu M , Green B , Labagnara K , Patel R , Loloi J , Watts K , Maria P , Lowe F , Small A 
Published: May 2023

Abstract

Introduction
Financial toxicity (FT) describes the direct and indirect financial burden associated with disease treatment. FT has been associated with adverse outcomes, including medication-rationing, psychological distress, and bankruptcy. Despite the well-described psychosocial impact of erectile dysfunction (ED), limited work has been performed to characterize its financial impact on patients.

Objective
We present the first study to directly report on the FT associated with ED management.

Methods
We performed a cross-sectional study of patients treated for ED in a diverse, urban academic medical center. Patients were surveyed with the validated COST tool (COmprehensive Score for financial Toxicity), the IIEF-5 (International Index of Erectile Function), and a 10-item social needs screener. The maximum score for the COST tool is 44, with lower scores indicating increased FT. Patients were stratified into “Moderate-to-Severe FT” (COST 25-0 points) and “Low FT” (COST &gt;26 points). Lower IIEF-5 scores similarly indicate more severe ED. FT score distributions were analyzed by patient characteristics and ED severity. Descriptive statistics, chi-square, linear regression, and Mann-Whitney U tests were performed using SPSS v28.

Results
48 patients were surveyed. 46% of patients identified as Hispanic, and 90% identified as non-white including 31% Black and 40% Latinx. Average age was 62.6 ± 9.0 years. Median ED severity was mild-moderate (IIEF5 Score = 13) and 73% of patients used oral ED medications. In the last year, 34% of respondents spent &lt;$100 on these medications, 23% spent $100-$499, 26% spent $500-$1000, and 9% spent &gt;$1000. Indirect costs of ED care were defined as cost of transportation to visits, copays, lab tests, or imaging. 40% of respondents spent nothing on indirect costs, 27% spent $100-$499, and 19% spent &gt;$500. Mean COST score was 26.7 ± 9.2 and “Moderate-to-Severe FT” was found in 48% of patients. Compared to those with "Low FT", the “Moderate-to-Severe FT” cohort had lower income (OR for annual income &lt;50,000 = 6.4, 95% CI 1.8 - 23.1, p=0.003), were less likely to have English as their first language (OR 0.25, 95% CI 0.07 - 0.8, p=0.02), were less likely to self-drive (OR 0.25, 95% CI 0.07 - 0.84, p=0.02), screened positively for more unmet social needs (mean difference 1.3, 95% CI 2.0 - 0.6, p&lt;0.001) and had more severe ED (mean IIEF score difference of 3.1, 95% CI 0.2 - 6.0, p=0.035). IIEF score was significantly correlated with COST Score (Spearmans rho correlation coefficient = -0.302, p=0.039).

Conclusions
Our findings suggest FT and unmet social needs may be related to ED severity. In addition to medical interventions, these patients may benefit from financial social services. 48% of our patients reported moderate or severe FT. As even moderate FT has been associated with cost-coping behaviors, like medication rationing, the clinical implications of these findings are potentially significant. We recommend that urologists inquire and investigate the financial burden incurred on their patients.

Disclosure
No