Primary urethral reconstruction: The cost minimized approach to the bulbous urethral stricture
Primary urethral reconstruction: The cost minimized approach to the bulbous urethral stricture
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DOI：
10.1097/01.ju.0000154971.05286.81
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发表时间：
2005-04-01
影响因子：
6.6
通讯作者：
Jordan, GH
中科院分区：
文献类型：
--
作者：
Rourke, KF;Jordan, GH
目的：尿道狭窄疾病的治疗通常需要在容易获得的直视内尿道切开术（DVIU）和高效但技术上更复杂的开放尿道重建术之间进行选择。使用短段球部尿道狭窄作为一个模型，我们确定哪种策略是成本较低的材料和方法：DVIU和开放尿道重建狭窄切除和主要吻合2厘米球部尿道狭窄的成本进行了比较，使用成本最小化决策分析模型。DVIU治疗组的临床概率估计值为出血风险、尿路感染风险和狭窄复发风险。初次尿道重建策略的估计值为伤口并发症的风险、扩大截石术的并发症和治疗失败的风险。直接第三方支付者的费用确定在2002年美元。结果：该模型预测，治疗与DVIU是更昂贵的（每例患者17,747美元）比立即开放尿道重建（每例患者16,444美元）。这产生了每名患者1，304美元的增量成本节省，有利于尿道重建。敏感性分析显示，在临床相关事件范围内，尿道成形术的初级治疗在经济上是有利的。结论：对于短段球部尿道狭窄，一期尿道重建术治疗费用较低。从财政的角度来看，在大多数临床情况下，尿道重建术应被认为优于DVIU。
Purpose: Treatment for urethral stricture disease often requires a choice between readily available direct vision internal urethrotomy (DVIU) and highly efficacious but more technically complex open urethral reconstruction. Using the short segment bulbous urethral stricture as a model, we determined which strategy is less costly.Materials and Methods: The costs of DVIU and open urethral reconstruction with stricture excision and primary anastomosis for a 2 cm bulbous urethral stricture were compared using a cost minimization decision analysis model. Clinical probability estimates for the DVIU treatment arm were the risk of bleeding, urinary tract infection and the risk of stricture recurrence. Estimates for the primary urethral reconstruction strategy were the risk of wound complications, complications of exaggerated lithotomy and the risk of treatment failure. Direct third party payer costs were determined in 2002 United States dollars.Results: The model predicted that treatment with DVIU was more costly ($17,747 per patient) than immediate open urethral reconstruction ($16,444 per patient). This yielded an incremental cost savings of $1,304 per patient, favoring urethral reconstruction. Sensitivity analysis revealed that primary treatment with urethroplasty was economically advantageous within the range of clinically relevant events. Treatment with DVIU became more favorable when the long-term risk of stricture recurrence after DVIU was less than 60%.Conclusions: Treatment for short segment bulbous urethral strictures with primary reconstruction is less costly than treatment with DVIU. From a fiscal standpoint urethral reconstruction should be considered over DVIU in the majority of clinical circumstances.