A review of publicly available policies showed that most plans do not specify coverage criteria in the cases of rehabilitation post prostatectomy. One managed care organization, the Regence Group, specifically stated that the use of PDE-5 inhibitors for preservation of penile function after radical prostatectomy is investigational (
link to the Regence Group’s policy).
Of note, two related randomized placebo-controlled studies were published in July of 2008:
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Padma-Nathan et al. Randomized, double-blind, placebo-controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Int J Impot Res. ePub ahead of print, July 24, 2008. - 76 men (enrollment was prematurely stopped due to low response rates) were randomized to sildenafil 50 mg, sildenafil 100 mg, or placebo nightly for 36 weeks. Spontaneous erectile function occurred in 27% of the sildenafil group vs 4% of the placebo group (p < 0.02).
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Montorsi et al. Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve-sparing radical prostatectomy. Eur Urol. ePub ahead of print, July 9, 2008. – 628 men were randomized to nightly vardenafil, on-demand vardenafil, or placebo for 9 months, followed by a 2-month washout period. After the washout period, differences in the percentages of patients with the International Index of Erectile Function erectile function domain score of >=22 were not statistically significant.