Pd52-08 Adherence to Intracavernosal Injection Relative to Prescriber Choices and Patient Income

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (PD52)1 May 2024PD52-08 ADHERENCE TO INTRACAVERNOSAL INJECTION RELATIVE TO PRESCRIBER CHOICES AND PATIENT INCOME Nicholas A. Deebel, Connor G. Policastro, Rory Ritts, and Ryan P. Terlecki Nicholas A. DeebelNicholas A. Deebel , Connor G. PolicastroConnor G. Policastro , Rory RittsRory Ritts , and Ryan P. TerleckiRyan P. Terlecki View All Author Informationhttps://doi.org/10.1097/01.JU.0001009412.04863.1b.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intracavernosal injection (ICI) for erectile dysfunction (ED) is considered for select patients, typically when oral medications fail or are poorly tolerated. Alprostadil is the only single agent approved for ICI, but data suggests compounded formulations (e.g., Trimix) may be more commonly prescribed. In addition to poor tolerance related to pain or priapism, adherence to ICI may be affected by lack of efficacy and/or financial toxicity. We sought to determine rates of formulation adjustments and adherence to therapy based on economic analysis. METHODS: As part of an IRB-approved study, all instances of dispensed ICI by the area's only compounding pharmacy and prescribed from within our tertiary care center from 2013-2023 were reviewed. Data was collected on patient age, dispensed formulations, number of refills, and median income as determined by zip-code. Logistic regression was used to determine association between patient factors and adherence to ICI. RESULTS: 540 men (mean age 67.2±11.6 years) were evaluated. Mean annual income by zip-code was $56,560±$15,354. Among initial prescriptions (IRx), mean concentrations of prostaglandin E1 (PGE1), papaverine, and phentolamine were 21.3±20.7 mcg/mL, 23.3±6.1 mg/mL, and 0.97±0.45 mg/mL, respectively. ICI mostly commonly involved a three-agent formulation (452/540, 83.7%), followed by single agent PGE1 (85/540, 15.7%). Refills of IRx were obtained by 163/540 (30.1%) men, and 139/540 (25.7%) progressed to an adjusted formulation after the initial trial. 238/540 (44.1%) men ceased receipt of ICI after IRx. On univariate analysis, high-dose PGE1 (>20 mcg/mL) was significantly associated with discontinuation after IRx (p=0.03). Binary logistic regression including age, income, and PGE1 dose did not demonstrate a significant association, although decreasing income approached significance (p=0.079). CONCLUSIONS: Greater than 40% of men will fail to refill ICI altogether, which appears to be independent of income. Less than a third of men who obtain an IRx for ICI will refill the prescription at the same formulation, and higher concentration of PGE1 may be relevant. Future work should investigate the role of standardization of ICI prescribing and titration, as well as patient and provider education. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1075 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nicholas A. Deebel More articles by this author Connor G. Policastro More articles by this author Rory Ritts More articles by this author Ryan P. Terlecki More articles by this author Expand All Advertisement PDF downloadLoading ...