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But he argues that insurance carriers pay for many other illnesses -- such as migraine headaches -- that affect the quality but not the length of a person's life. "It looks like when insurance companies were deciding whether to cover Viagra, they probably didn't use a cost-effectiveness analysis [to make the decision]," he says. "It would appear that their decisions have been arbitrary. " In an editorial, Michael R. McGarvey, MD, says Smith and colleagues did their math the right way. But McGarvey, who is chief medical officer for Horizon Blue Cross Blue Shield of New Jersey, says they drew the wrong conclusions about what this means for insurance coverage.

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