How Much Does The Department of Defense Love Viagra?

From 2011 through 2014, the Defense Health Agency spent nearly $300 million on impotence drugs for military beneficiaries, including active-duty personnel, retirees, and eligible family members.
From 2011 through 2014, the Defense Health Agency spent nearly $300 million on impotence drugs for military beneficiaries, including active-duty personnel, retirees, and eligible family members.

The Defense Health Agency, a branch of the Department of Defense, reportedly spent more than $84 million in 2014 on medications to treat erection problems. Of that total, $41.6 million, or almost half, was spent on Viagra, the first of the new wave of impotence drugs to hit the market beginning in the late 1990s.

Since 2011, the agency has spent $294 million for impotence drugs — the equivalent of nearly four U.S. Air Force F-35 Joint Strike Fighters.

During 2014 alone, according to DHA data, military beneficiaries — active-duty personnel, retirees, and eligible family members — filled 1.18 million prescriptions for PDE5 inhibitors, the family of impotence drugs that includes Viagra, Levitra, Cialis, Staxyn, and Stendra.

PDE5 Inhibitors

This category of drugs gets its name from their ability to temporarily disable the phosphodiesterase-5 enzyme and thus promote strong blood flow to the penis, facilitating the erectile function.

Although the vast majority of the PDE5 inhibitors are prescribed for impotence, drugs carrying this classification are sometimes prescribed for other purposes. An example of this would be Revatio, which has the same active ingredient — sildenafil citrate — as Viagra but is prescribed for the treatment of pulmonary arterial hypertension — high blood pressure in the lungs.

Although Revatio was included in the overall DHA data on spending for PDE5 inhibitors, it accounted for just a small portion of overall spending. The DHA reported that 1,699 prescriptions for Revatio were filled in 2014, racking up total costs of $2.24 million.

Viagra Most Popular

As to preferences for impotence drugs among DHA’s military beneficiaries, Viagra was by far the most popular of these drugs. Of the 1.18 million prescriptions for PDE5 inhibitors filled in 2014, 905,083 were for Viagra. Cialis was a distant second, accounting for a total of 185,841 prescriptions with a dollar value of $22.82 million.

Interestingly, less than 10 percent of the prescriptions — 102,885 scripts — for impotence drugs were for active-duty troops. This amounted to a total expenditure of $7.67 million in 2014, according to DHA. Although the DHA data doesn’t clearly identify what percentage of the prescriptions were for veterans, it seems likely that they may account for the lion’s share of spending on impotence drugs.

Data from the Armed Forces Health Surveillance Center indicate the incidence of erection problems among active-duty military men increased sharply from 2004 through 2013.
Data from the Armed Forces Health Surveillance Center indicate the incidence of erection problems among active-duty military men increased sharply from 2004 through 2013.

These reports on DHA spending for impotence drugs come against the backdrop of recent data showing a sharp increase in the incidence of erection problems among active members of the U.S. armed forces.

Psychogenic Impotence

In sharp contrast to their civilian counterparts, men in the military tend to experience a higher percentage of erection problems that are psychogenic in origin. In a recent report the percentage of impotence of psychological origin among military men was 48 percent, almost half the population studied. Among civilians, impotence of psychological origin is said to account for only 10 to 20 percent of all erection problems.

While the new wave of PDE5 inhibitors is very effective among men whose erection problems can be attributed to compromised blood flow to the penis, they are of less use for those whose impotence is psychological in origin. Despite the unusually high percentage of psychogenic impotence among military men, just over half of the active-duty military men do have erection problems that are physiological in origin.

AFHSC Report

A related report, released by the Armed Forces Health Surveillance Center in the fall of 2014, showed that the overall incidence of erection problems among active-duty military men had increased sharply in the decade from 2004 through 2013.

According to the AFHSC, the crude incidence rate of erection problems among active military men in 2004 was 5.8 cases per 1,000 person-years. Ten years later, in 2013, the rate had jumped to 12.6 cases per 1,000 person-years.

Because the U.S. active-duty military population fluctuates so widely from year to year, military statisticians prefer to use the ¨person-years” measurement, which is ¨the product of the number of years times the number of members of a population who have been affected by a certain condition,¨ according to Stedman’s Medical Dictionary.

Army Has Most Cases

Of the 100,248 cases of impotence diagnosed among military men between 2004 and 2013, the U.S. Army accounted for 48,445 cases, or an incident rate of 10.9 cases per person-years. A total of 20,805 cases were diagnosed among members of the U.S. Air Force, representing an incident rate of 7.8 cases per 1,000 person-years. Among active-duty members of the U.S. Navy, a total of 20,281 cases were recorded, accounting for an incident rate of 7.3 cases per 1,000 person-years. The 7,822 cases diagnosed among members of the U.S. Marine Corps represented an incident rate of 4.4, while among active-duty members of the U.S. Coast Guard, the incident rate was 8.3.

Among all ethnic and racial groups, African-American men had the highest incidence of erection problems.
Among all ethnic and racial groups, African-American men had the highest incidence of erection problems.

In a demographic breakdown of the 2004-2013 impotence data from the AFHSC, black, non-Hispanic men accounted for a total of 25,687 cases, or an incident rate of 15 cases per person-years. This is more than twice the incident rate found among white, non-Hispanic men who accounted for 54,790 cases and a rate of only 7 cases per person-years. Hispanic men had a total of 10,323 cases and an incident rate of 8.1, while Asian/Pacific Islanders had an incident rate of 9.1 and 4,262 cases. The lowest incident rate among all demographic groups was 4.1 for American Indian/Native Alaskans who accounted for a total of 570 cases.

Rate High Among Those Never Deployed

Although the military report noted a link between erection problems and post-traumatic stress disorder, the data showed that the highest incidence of impotence came among military men who had never deployed. The incident rate for this group was 10.1, from a total of 29,242 cases. Servicemen who had one or two deployments had an incident rate of 8.4, while those with three or more deployments had an incident rate of 6.7.

In yet another area, the incidence of erection problems among military men diverged from patterns seen among civilian men. While studies of the general population have shown that erection problems are more common among men with lower education levels, the opposite result was observed in the military data.

Among men whose educational background included high school or less, the incident rate was 6.9 and a total of 59,425 cases. Military men who had at least some college accounted for 15,080 cases and an incident rate of 14.8. Men who had earned a bachelor’s degree accounted for 13,101 cases and an incident rate of 9.8, while those with advanced degrees had an incident rate of 13.8 and a total of 9,889 cases.

Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.

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