Cost-Effectiveness of Risk Stratified Followup after Urethral Reconstruction: A Decision Analysis
Cost-Effectiveness of Risk Stratified Followup after Urethral Reconstruction: A Decision Analysis
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DOI：
10.1016/j.juro.2013.04.024
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发表时间：
2013-10-01
影响因子：
6.6
通讯作者：
Morey, Allen F.
中科院分区：
文献类型：
--
作者：
Belsante, Michael J.;Zhao, Lee C.;Morey, Allen F.
目的：我们提出一种新的风险分层随访方案，用于尿道成形术后，并探讨潜在的成本节约。材料和方法：采用基于症状的风险分层方案，对接受切除术和一期吻合尿道成形术的患者进行决策分析，并与标准方案进行密切随访。模型假设包括切除和一期吻合的成功率为94%，成功尿道成形术的患者中有11%有持续的下尿路症状需要膀胱镜评估，治疗失败的患者需要进行尿道切开术，根据症状监测复发的患者需要延迟诊断，需要耻骨上管引流。对2010年全国住院患者样本进行了查询，以确定美国每年进行尿道成形术的数量。成本是根据医疗保险报销率获得的。结果：基于症状的风险分层随访方案的5年成本为每位患者430美元，而使用标准密切随访实践的每位患者2,827美元。据估计，2010年美国进行了7761例尿道成形术。假设60%是切除和一期吻合，随访超过5年，风险分层方案预计可节省11165130美元。敏感性分析显示，在所有情况下，基于症状的风险分层随访方案远比标准的密切随访更具成本效益。使用风险分层随访方案，预计不到1%的患者会出现无症状复发。结论：采用风险分层、基于症状的方法进行尿道成形术随访可显著降低医疗费用，同时减少不必要的随访、侵入性检查和辐射暴露。
Purpose: We propose a novel risk stratified followup protocol for use after urethroplasty and explore potential cost savings.Materials and Methods: Decision analysis was performed comparing a symptom based, risk stratified protocol for patients undergoing excision and primary anastomosis urethroplasty vs a standard regimen of close followup for urethroplasty. Model assumptions included that excision and primary anastomosis has a 94% success rate, 11% of patients with successful urethroplasty had persistent lower urinary tract symptoms requiring cystoscopic evaluation, patients in whom treatment failed undergo urethrotomy and patients with recurrence on symptom based surveillance have a delayed diagnosis requiring suprapubic tube drainage. The Nationwide Inpatient Sample from 2010 was queried to identify the number of urethroplasties performed per year in the United States. Costs were obtained based on Medicare reimbursement rates.Results: The 5-year cost of a symptom based, risk stratified followup protocol is $430 per patient vs $2,827 per patient using standard close followup practice. An estimated 7,761 urethroplasties were performed in the United States in 2010. Assuming that 60% were excision and primary anastomosis, and with more than 5 years of followup, the risk stratified protocol was projected to yield an estimated savings of $11,165,130. Sensitivity analysis showed that the symptom based, risk stratified followup protocol was far more cost-effective than standard close followup in all settings. Less than 1% of patients would be expected to have an asymptomatic recurrence using the risk stratified followup protocol.Conclusions: A risk stratified, symptom based approach to urethroplasty followup would produce a significant reduction in health care costs while decreasing unnecessary followup visits, invasive testing and radiation exposure.