In men over 45 years, prostate cancer is the most common form of cancer. For this group of men, attention to quality of life and especially sexuality is of great importance. All possible treatments for prostate cancer cause to some extent functional damage as well as psychological problems, resulting in a wide range of sexual disturbances. Known sexual consequences of treatment include reduced desire, erectile dysfunction, anejaculation, orgasm disorders, loss of urine during the orgasm (climacturia) and change in length and shape of the penis.
A man with prostate cancer has not only to deal with uncertainty of the course of the disease, but has also to deal with physical, cognitive and sexual problems and changes in relationship with his partner. Where the medical literature had mainly attention to the loss of an erection, there is now more attention to other sexual disturbances caused by the treatment of prostate cancer.
For some men, the medical interventions work well for those sexual dysfunction, but erection and orgasm are just ingredients and not the whole sexual recipe. An extensive multidisciplinary approach is needed to understand and optimize the needed help for the men and their partners.
Objectives: In a randomized controlled trial brief sex counselling (BSC), intensive sexual healthcare (ISH) and no treatment (NT) for adolescents with a sexual dysfunction were compared. The aim of this study was to assess the cost-effectiveness and cost-utility of BSC versus ISH and NT from a societal perspective.
Methods: Costs, sexual functioning and quality of life were measured during 6 months. Primary outcome measures were measured with the Female Sexual Functional Index, the International Index of Erectile Function and the utilities reflecting Quality of Life based on the SF-36. Uncertainty was dealt with by using bootstrap replications and sensitivity analyses.
Results: Results show that the societal costs were the highest for ISH followed by NT and BSC. The difference in costs between ISH compared to NT and BSC was significant. Furthermore, there were no significant group differences in sexual functioning or quality of life. With respect to the cost-effectiveness and cost-utility, BSC can be considered to be a suitable treatment for adolescents with a sexual dysfunction.
Conclusion: Due to the lack of a significant difference in clinical effect, it can be concluded that BSC is the cheapest treatment option when implementing the intention-to-treat, besides a no treatment option, for adolescents with a sexual dysfunction.