Weinberger JM. et al., 2022: Shock Wave Therapy for Erectile Dysfunction: Marketing and Practice Trends in Major Metropolitan Areas in the United States.
Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Introduction: Due to the increasing prevalence of erectile dysfunction (ED) and pronounced distress for patients, a direct-to-consumer market for shock wave therapy (SWT) has emerged. We sought to evaluate trends in marketing and implementation of SWT as a restorative treatment for ED in large metropolitan areas by investigating cost to patients, provider credentials and treatment protocols.
Methods: SWT providers in 8 of the most populous metropolitan areas were identified using Google search. Search queries included: "Shockwave therapy for erectile dysfunction in [city];" "Shockwave therapy for ED in [city];" and "GAINSWave in [city]." All clinics advertising SWT for ED within the boundaries of the selected metropolitan area were included. Using a "secret shopper" methodology, clinics were contacted by telephone with the goal of identifying the pricing, duration and provider administering the treatment.
Results: Across 8 of the most populous cities in the U.S., 152 clinics offered SWT as a treatment for ED. Comprehensive information was available for 65% of the clinics; 25% of providers offering SWT were urologists while 13% were not physicians. The average price per treatment course was $3,338.28. Treatment duration was highly variable and ranged from 1 to indefinite courses based on individual patient circumstance.
Conclusions: SWT, as a restorative therapy for ED, is performed primarily by nonurologists and is not standardized. Direct-to-consumer marketing is used to target distressed men. This study highlights concerning trends in major metropolitan markets, given the substantial financial impact for patients and inconsistent credentials among providers. Further, these findings suggest that patients are frequently seeking care for ED from nonurologists.
Urol Pract. 2022 May;9(3):212-219. doi: 10.1097/UPJ.0000000000000299. Epub 2022 Apr 5.PMID: 37145540
The article starts by noting the rising prevalence of ED globally and the growth of the ED therapy market. It highlights the increase in ED cases among younger men and the high demand for ED therapies, leading to the emergence of direct-to-consumer (DTC) marketing platforms. The article also mentions the significant financial impact of ED pharmaceuticals and the popularity of the DTC platform "Hims."
The research article focuses on regenerative therapies for ED, including platelet-rich plasma, low intensity shock wave therapy, and stem cell therapy. It acknowledges the lack of high-quality evidence supporting these therapies and mentions that the American Urological Association (AUA) and the Sexual Medicine Society of North America (SMSNA) designate SWT as investigational.
The article highlights the dominance of GAINSWave, a practitioner database and DTC advertising platform, in the shock wave therapy market segment. It discusses the expansion of for-profit men's clinics into offering restorative therapies such as SWT.
To evaluate trends in marketing and implementation of SWT as a treatment for ED, the researchers conducted a cross-sectional analysis using a "secret shopper" approach. The “secret shopper” method involves inquiring about services as a prospective patient. They examined men's health clinics in eight major metropolitan areas in the United States, including Los Angeles, New York, Houston, Washington, D.C., Philadelphia, Atlanta, Boston, and Dallas.
The findings indicate that SWT for ED is primarily performed by non-urologists, with only a quarter of providers trained in urology (25%). This does not reflect the situation in Central Europe, but in Scandinavian Countries, where ESWT for ED is mainly provided by physiotherapists. However, the indication for the treatment is provided by urologists. The German Society of Shock Wave Lithotripsy and Therapy (DGSWL) tries to increase the use by urologist by offering Certified Courses. There is no doubt, that ED can portend significant morbidities. Thus, patients contending with ED should be evaluated by urologists who are equipped to conduct a formal men’s health evaluation and provide a data- driven and patient-centric discussion of treatment options.
The study also reveals the considerable cost to patients and the lack of standardized treatment protocols among clinics. The researchers emphasize the inconsistent credentials among providers and the lack of evidence-based messaging in the market.
Limitations are that the 8 populous metropolitan areas selected may not be representative of other large metropolitan areas nor small metropolitan or rural areas. Further, a fraction of the cohort (18%) indicated that a formal consultation with a provider was required before pricing and protocol could be deter- mined. This may have biased the sample toward clinics offering more of a “one-size-fits-all” approach.
The article concludes by discussing the need for urologists to take the lead in reaching and treating patients with ED, given their expertise in men's health. It acknowledges the limitations of the study and suggests future directions for research, including a cost-effectiveness analysis of SWT for ED.