PURPOSE: The 2012 American Urological Association Clinical Effectiveness Protocol for the Management of Ureteral Calculous Disease recommends routine post-operative imaging after ureteroscopy.
We evaluated the cost-effectiveness of routine post-operative imaging after ureteroscopy (URS).
MATERIALS AND METHODS: A literature search was conducted to determine the risk of complications after routine URS for stones, including incidence of post-operative pain, stricture and silent obstruction. Sequela of renal loss due to undiagnosed silent obstruction may include chronic kidney disease, end-stage renal disease and cardiovascular disease. Imaging and procedure costs were obtained from Medicare reimbursement rates and the literature. Costs and prevalence of lifetime complications associated with silent loss of one kidney were obtained from the renal donor transplant literature. A decision tree was constructed using TreeAge PRO HEALTHCARE software to calculate the cost of a strategy of routinely imaging all patients after URS versus selective imaging based on post-operative pain. One and two-way sensitivity analyses were performed.
RESULTS: The average cost per patient of a strategy of routine post-URS imaging for all patients is $5,326 versus $5,196 for a strategy of selective imaging based on post-operative pain. Assuming a 2% rate of silent obstruction, the cost per kidney saved is $6,262.
CONCLUSION: While routine post-operative imaging carries a $130 per patient incrementally higher cost over a strategy of selective imaging in patients with post-operative pain, prevention of renal loss and its attendant morbidity justify the additional modest cost.
Written by:
Sutherland TN, Pearle MS, Lotan Y. Are you the author?
Department of Urology, University of Texas Southwestern Medical Center, J8.122, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
Reference: J Urol. 2012 Dec 28. pii: S0022-5347(12)06000-4.
doi: 10.1016/j.juro.2012.12.059
PubMed Abstract
PMID: 23276510
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