An Online Investigation Into Direct-to-Consumer Men's Health Clinics: The Who, What, and Where

Dietrich, Peter N; Doolittle, Johnathan; Brink, Sarah; Hanna, Daniel; Fitzgerald, John; Dadhich, Pranav; Sandlow, Jay; Kansal, Jagan; Bajic, Petar

doi:10.1016/j.urology.2023.01.026

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…Furthermore, our model did not account for potentially lower costs associated with obtaining these medications online, particularly with the emergence of direct-to-consumer men's health and online prescriptions. A study aimed at characterizing this model revealed that 65% offer ED treatment, yet only 10.3% had a urologist as a primary provider [34]. Given the novelty of these services, further investigation is needed to understand how this model may increase accessibility to ED treatment.…”

Section: Discussionmentioning

confidence: 99%

Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis

Nguyen,

McGovern,

Rojanasarot

et al. 2024

Int J Impot Res

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Patient out-of-pocket (OOP) cost represents an access barrier to erectile dysfunction (ED) treatment. We determined OOP cost for men with ED covered by Fee-for-Service Medicare. Coverage policies were obtained from the Medicare Coverage Database for treatments recommended by the 2018 American Urological Association (AUA) guidelines. OOP cost was retrieved from the 2023 Centers for Medicare & Medicaid Services Final Rule. OOP cost for treatments without Medicare coverage were extracted from GoodRx® or literature and inflated to 2022 dollars. Annual prescription costs were calculated using the published estimate of 52.2 yearly instances of sexual intercourse. Medicare has coverage for inflatable penile prostheses (IPP; strong recommendation), non-coverage for vacuum erection devices (VED; moderate recommendation) and phosphodiesterase type-5 inhibitors (PDE5i; strong recommendation), and no policies for intracavernosal injections (ICI; moderate recommendation), intraurethral alprostadil (IA; conditional recommendation), or low-intensity extracorporeal shock wave therapy (ESWT; conditional recommendation). Annual IA prescription is most costly ($4022), followed by ICI prescription ($3947), one ESWT course ($3445), IPP ($1600), PDE5i prescription ($696), and one VED ($213). PDE5i and IPP, both strongly recommended by AUA guidelines, are associated with lower OOP cost. Better understanding of patient financial burden may inform healthcare decision-making.

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Section: Discussionmentioning

confidence: 99%

Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis

Nguyen,

McGovern,

Rojanasarot

et al. 2024

Int J Impot Res

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“…However, with the rise of telemedicine and direct-to-consumer men’s clinics providing testosterone injections and ED therapy, there is a concern for inadequate physician oversight of APPs. 23 Thus, there should also be a growing emphasis on urology-focused APP training and credentialing.…”

Section: Discussionmentioning

confidence: 99%

Increasing Role of the Advanced Practice Provider in Men’s Health Clinics: An Analysis of Medicare and Commercial Claims in the United States

et al. 2023

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Introduction:As urological care delivery in the U.S. continues to evolve to meet patient needs, we aim to clarify the role of advanced practice providers for publicly and privately insured patients in the treatment of male urological conditions commonly encountered in men’s health clinics.Methods:Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and Merative MarketScan Commercial Database were queried for procedures submitted by advanced practice providers between 2010 and 2021. Common urological conditions were identified using Current Procedural Terminology codes and grouped into 4 categories: testicular hypofunction, erectile dysfunction and Peyronie’s disease, benign prostatic hyperplasia, and scrotal pain. The proportion of procedures submitted by advanced practice providers was calculated for each year and category.Results:From 2010 to 2021, the proportion of advanced practice provider–submitted service counts for each condition within the MarketScan group increased up to 5-fold, with benign prostatic hyperplasia representing the greatest growth. The proportion of advanced practice provider–submitted service counts within the Medicare group increased up to 8-fold, with erectile dysfunction/Peyronie’s disease representing the greatest fold change. The proportion of claims submitted by advanced practice providers treating all 4 conditions was higher in 2021 than 2010 in both publicly and privately insured groups.Conclusions:The role of advanced practice providers in men’s urological health is increasing for both privately and publicly insured patient populations. Advanced practice providers play a critical role in urological care and can help to improve access to men’s health.

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“…In addition, a separate study reported that urologists were listed as the primary provider in only 10.3% of these direct-to-consumer online clinics. 20 Other providers included internal medicine physicians (17.4%), family medicine physicians (11.1%), and advanced practice providers (nurse practitioner or physician assistant, 4.5%); 20.1% of clinics did not list their providers. Our findings highlight how this approach may have negative implications for the longevity and future health of men with testosterone deficiency as they may miss the opportunity to be evaluated in person for any underlying associated cardiometabolic issues that would prompt the appropriate workup, treatment, or referral to subspecialty care.…”

Section: Discussionmentioning

confidence: 99%

Integrated Urology and Primary Care Model Improves Outcomes for Men With Testosterone Deficiency

Nguyen,

Berrios,

Leonard

et al. 2023

Urology Practice

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Introduction:Many men presenting with testosterone deficiency do not have access to a primary care provider. We sought to integrate primary care into initial urological evaluation to better identify and manage undertreated comorbidities.Methods:New patients presenting with testosterone deficiency were offered primary care provider evaluation within a men’s health center between October 2019 and 2022. Data collected from the electronic health record included age, race, BMI, access to prior primary care provider, new diagnoses, prescriptions, and referrals.Results:Eighty-one men were evaluated over the 3-year study period. Thirty-three men (41%) did not have a preexisting primary care provider. Older men were significantly more likely to have a preexisting primary care provider (OR 1.06 [95% CI: 1.02-1.10], P < .001). Hispanic men were significantly less likely to have an existing primary care provider (OR 0.16 [95% CI: 0.03-0.84], P = .01). Forty-eight men (59%) established continuity of care. Newly diagnosed comorbidities included hypertension (41%), obesity (37%), hyperlipidemia (27%), obstructive sleep apnea (25%), depression (23%), and diabetes (14%). Forty-one patients (51%) were prescribed a new medication. Twenty-one patients (26%) were referred to nutrition, with mean BMI decrease of 1.75 kg/m2. Twenty-six patients (32%) underwent sleep medicine evaluation for obstructive sleep apnea. Twenty-seven (33%) and 37 patients (46%) received a flu vaccination and immunization updates. Eleven patients (14%) were referred for screening colonoscopy.Conclusions:This is the first report of integrated primary care and urology evaluation for testosterone deficiency. This comprehensive model results in improved outcomes including increased access to subspecialty referrals, objective weight loss, treatment of new diagnoses, updated immunizations, and cancer screening.

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An Online Investigation Into Direct-to-Consumer Men's Health Clinics: The Who, What, and Where

Cited by 4 publications

References 23 publications

Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis

Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis

Increasing Role of the Advanced Practice Provider in Men’s Health Clinics: An Analysis of Medicare and Commercial Claims in the United States

Integrated Urology and Primary Care Model Improves Outcomes for Men With Testosterone Deficiency

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