What does a penile implant cost?
Clinical guidelines do not give a price for a penile implant, and the cost depends on the country, the hospital, the device and the insurance plan. Guidelines do treat cost as a real factor in the decision. Treatment costs are among the most common barriers to ED treatment, while satisfaction with implant surgery reaches 92% to 100% of patients.
Why do guidelines not list a price for a penile implant?
Clinical guidelines decide who may benefit from a treatment, not what it costs. Prices for implant surgery depend on the country, the hospital, the type of device and the way the operation is funded, so a single figure would not apply to most men. Funding rules and insurance cover also differ between countries and between individual insurance plans, and coverage is decided by each plan rather than by a guideline.
The European guideline still places cost inside the clinical decision. It describes a tailored treatment plan for erectile dysfunction that weighs invasiveness, efficacy, safety, costs and patient preference.
"This highlights the importance of clinicians understanding patient's beliefs about ED treatment, therapeutic ineffectiveness, adverse effects, quality of intimate relationships and treatment costs, all of which were shown to be the most prevalent barriers to treatment use." Source 1, p. 47
How does cost affect the choice of implant?
The American guideline lists cost concerns as one of the situations in which a malleable implant may be more appropriate than an inflatable one, although satisfaction is generally higher with inflatable devices.
A semi-rigid implant also involves a simpler operation. In men who need an implant after priapism, the European guideline bases the choice of device on patient suitability, surgeon experience and the availability and cost of equipment. In the same setting, a malleable implant can later be exchanged for an inflatable one.
What can add to the cost after the first operation?
Mechanical failure and infection are the two main complications, and either can lead to a further operation. In a database of 7,666 men with a first implant, 11% needed another operation, and about half of these were for mechanical failure.
An infected implant usually has to be removed. When a new device cannot be placed in the same operation, the tissues heal for six weeks to six months before a delayed replacement, which is a more complex operation. Infection affects 2% to 3% of first implants in low-risk men at high-volume centres, and 1% to 2% with coated devices.
How do outcomes compare with the cost?
Satisfaction with implant surgery is among the highest of any treatment for erectile dysfunction, at 92% to 100% in patients and 91% to 95% in partners, with appropriate counselling. The European guideline finds enough evidence to recommend implants for men who do not respond to less invasive treatments, because of their high efficacy, safety and satisfaction.
In the American guideline's review, mean satisfaction was 86.2% with inflatable models and 75.1% with malleable models, which matters when cost makes a malleable device the more practical choice. Insurance cover is a separate question, decided by each plan rather than by a guideline.