340 A COST EFFECTIVENESS AND UTILITY STUDY OF LONG TERM URODYNAMIC MONITORING AND ITS RELATIONSHIP TO RENAL DYSFUNCTION IN THE SPINAL CORD INJURED POPULATION (2010)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2010340 A COST EFFECTIVENESS AND UTILITY STUDY OF LONG TERM URODYNAMIC MONITORING AND ITS RELATIONSHIP TO RENAL DYSFUNCTION IN THE SPINAL CORD INJURED POPULATION Lynn Stothers Lynn StothersLynn Stothers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES International bodies have suggested that urodynamic studies are mandatory in the neurogenic population related to the monitoring of bladder storage parameters in follow up protocols in an effort to reduce renal dysfunction in the SCI population. Such protocols are labor and investigation intensive. The purpose of this study was to model the cost effectiveness and utility of a standardized long term urologic protocol in the management of SCI patients. METHODS Cost effectiveness and utility measurements were performed coincidental with a 10 year longitudinal neurogenic protocol in 150 complete SCI (92 male 58 female). Subjects were seen annually at a tertiary care teaching hospital and completed a protocol including video urodynamics, 24 hour creatinine clearance and renal ultrasound according to a standardized follow up protocol. Markov decision models were used to tabulate costs and quality adjusted life years (QUALY's) accumulated in each subject. Unit costs related to physician care and urodynamics were taken from medical services plan reimbursement rates. Comparison was available to 58 SCI subjects who had undergone patient initiated follow up. Data were analyzed in a cost-utility framework from a governmental single payer perspective over the 10 year time horizon including sensitivity analysis. RESULTS Patients who underwent annual follow up with urodynamics accrued greater QUALY's (0.01, 95% CI 0.00, 0.02) and lower costs over 10 years compared to those who presented based on symptoms alone. Three or more increased storage parameters together (detrusor compliance, detrusor leak point pressure and maximum detrusor contraction pressure) increased the risk of renal dysfunction 3 fold over a 10 year period of time. Annual follow up with the protocol was cost effective (incremental cost effectiveness ratio of $35,500 per QUALY) compared to patient initiated follow up. This was due principally to the reduction in renal dysfunction and hospitalizations seen in patient's undergoing annual follow up compared to patients who self presented. Univariate and multivariate probabilistic sensitivity analyses suggested that these results were robust. CONCLUSIONS Standardized follow up protocols including urodynamics although labor intensive are cost effective due to the reduction in renal dysfunction seen in the long term in the SCI population. Cost savings were seen through a reduction in the need for treatment of upper tract complications such as pyelonephritis and reduction in the need for dialysis. Vancouver, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e135 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lynn Stothers More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...