Cost Comparison of Topical Testosterone Agents

San Antonio—Male hypogonadism (HG) is associated with a number of chronic conditions, including decreased bone and muscle mass, sexual dysfunction, hypertension, hyperlipidemia, diabetes, back and neck pain, and psychiatric disorders. The combination of these comorbidities often accounts for greater healthcare costs than the occurrence of HG alone.

A recent study was conducted to assess the daily maintenance dose and third-party payer costs of testosterone replacement therapy (TRT) among patients using topical testosterone agents (TTA). TTAs are the most commonly prescribed form of TRT, and usually require a higher dose to attain and maintain normal testosterone levels. Prior to this, no study had assessed the daily dose and cost to third-party payers of TTAs for HG. A. Kaltenboeck and colleagues presented findings from their study of this issue during the AMCP meeting. The poster was titled Daily Dose and Costs Associated with Maintenance Therapy of Topical Testosterone Agents.

The study used a de-identified, privately-insured dataset covering approximately 15.5 million lives from 60 US-based companies in a number of different industries. Patients with ≥1 prescription drug claim for testosterone topical solution, testosterone gel 1%, testosterone gel 1.62%, or testosterone gel between January 1, 2011, and March 31, 2012 were identified. Patients eligible for study inclusion were required to be aged ≥18 years, male, have continuous health plan eligibility, and no claim for the same TTA in the 12 months prior to the study index date, defined as the earliest prescription claim for a TTA.

The study participants were initiated at the recommended starting dose (RSD) and stratified into 1 of the 4 different TTA cohorts: testosterone topical solution (RSD 60 mg per day; n=345), testosterone gel 1% RSD 50 mg per day; n=1552), testosterone gel 1.62% (RSD 40.5 mg per day; n=523), or testosterone gel (50 mg per day; n=1050).

Dose per-patient per-day (PPPD) was calculated in each month for the 6 months following the index date. Risk-adjusted dose and third-party payer costs PPPD were estimated in the month with maintenance dose attainment. Maintenance dose was attained at month 4, when all cohorts had no statistically significant differences in mean dose PPPD.

The study results found that testosterone topical solution patients were more likely than any other cohort o have an HG diagnosis (60.6% vs 39.6%-53.1%; P<.001-P<.016, respectively). Testosterone topical solution also had the lowest Charlson Comorbidity Index (0.6 vs 0.8-1.2; P=.346-P=.004, respectively).

At month 4, mean dose PPPD in mg of testosterone as a proportion of RSD was 67.62 for testosterone topical solution, 55.94 for testosterone gel 1%, 48.85 for testosterone gel 1.62%, and 59.04 for testosterone gel. In addition, risk-adjusted dose PPPD as a proportion of RSD was 112% for testosterone topical solution, 112.2% for testosterone gel 1%, 120.4% for testosterone gel 1.62%, and 118% for testosterone gel.

At month 4, risk-adjusted third-party payer costs were $7.50 for testosterone topical solution, $9.48 for testosterone gel 1%, $9.85 for testosterone gel 1.62%, and $9.49 for testosterone gel (all P<.001).

Overall, the study authors report that maintenance dose as a proportion of RSD was the least among patients using testosterone topical solution and testosterone gel 1%. Testosterone topical solution also had lowest third-party payer costs for the maintenance dose, according to the study findings.

This research was supported by funding from Eli Lilly and Company.