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Tytuł pozycji:

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy.

Tytuł :
Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy.
Autorzy :
Luchristt D; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina (Dr. Luchristt); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois (Drs. Geynisman-Tan, Mueller, and Kenton). Electronic address: .
Geynisman-Tan J; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina (Dr. Luchristt); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois (Drs. Geynisman-Tan, Mueller, and Kenton).
Mueller MG; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina (Dr. Luchristt); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois (Drs. Geynisman-Tan, Mueller, and Kenton).
Kenton K; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina (Dr. Luchristt); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois (Drs. Geynisman-Tan, Mueller, and Kenton).
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Źródło :
Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2020 Dec 11. Date of Electronic Publication: 2020 Dec 11.
Publication Model :
Ahead of Print
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Original Publication: Philadelphia, PA : Elsevier, c2005-
Contributed Indexing :
Keywords: Bladder injury; Lower urinary tract injury; Ureteral injury
Entry Date(s) :
Date Created: 20201214 Latest Revision: 20210104
Update Code :
20210623
DOI :
10.1016/j.jmig.2020.12.004
PMID :
33310171
Czasopismo naukowe
Study Objective: To estimate the rate of lower urinary tract injury (LUTI) and percentage of LUTI needing to be recognized intraoperatively to make universal cystoscopy cost-effective and cost-saving during laparoscopic hysterectomy.
Design: A decision tree model was used to estimate the costs and quality-adjusted life years associated with delayed or intraoperative recognition of LUTI at the time of laparoscopic hysterectomy. Probabilities and utilities were estimated from published literature. Costs were estimated from Medicare national reimbursement schedules. Threshold analyses estimated the LUTI rate and cystoscopy sensitivity that would make universal cystoscopy cost-effective or cost-saving. Monte Carlo simulations were performed.
Setting: US healthcare system.
Patients: Individuals undergoing laparoscopic hysterectomy for benign indications.
Interventions: Theoretic implementation of a universal cystoscopy policy.
Measurements and Main Results: The total direct medical costs of laparoscopic hysterectomy under usual care were $8831 to $9149 and under universal cystoscopy were $8944 to $9068. When low LUTI rates (0.44%; estimated using sample-weighted estimates of retrospective and prospective data) were assumed, universal cystoscopy was only cost-effective in 17.1% of the simulations; the incremental cost was estimated to be $111 to $131. With median LUTI rates (2.3%) or high LUTI rates (4.0%; estimated using only prospective data with universal screening), the universal cystoscopy strategy was cost-effective in 93.9% and 99.6% of the simulations, respectively, and potentially cost-saving if the sensitivity of intraoperative cystoscopy for ureteral injury exceeded 65% or 31%, respectively. The estimated potential savings were $18 to $95 per hysterectomy. In threshold analysis assuming the average cystoscopy sensitivity rate, universal cystoscopy is estimated to be cost-effective when the LUTI rate exceeds 0.80%.
Conclusion: In our model, universal cystoscopy is the preferred approach for laparoscopic hysterectomy and is estimated to be cost-effective in contemporary clinical settings where the LUTI rate is estimated to be 1.8% and potentially cost-saving among higher-risk populations, including those with endometriosis or pelvic organ prolapse. If the LUTI rates are less than 0.75%, the estimated incremental costs are modest-up to $131 per case. Administrators and providers should consider the local LUTI rates and practice patterns when planning implementation of a universal cystoscopy policy.
(Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)

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