Abstract
Aims Urodynamic studies (UDS) are generally recommended prior to surgical treatment for stress urinary incontinence (SUI), despite insufficient evidence that it impacts treatment plans or outcomes in patients with uncomplicated SUI. This analysis aimed to calculate the cost incurred when UDS was performed as a supplement to a basic office evaluation and to extrapolate the potential savings of not doing UDS in this patient population on a national basis. Methods This is a secondary analysis from the Value of Urodynamic Evaluation (ValUE) trial, a multicenter non-inferiority randomized trial to determine whether a basic office evaluation (OE) is non-inferior in terms of SUI surgery outcomes to office evaluation with addition of urodynamic studies (UDS). All participants underwent an OE; those patients who randomized to supplementary UDS underwent non-instrumented uroflowmetry, filling cystometry, and a pressure flow study. Costs associated with UDS were calculated using 2014 U.S. Medicare allowable fees. Models using various patient populations and payor mixes were created to obtain a range of potential costs of performing UDS in patients undergoing SUI surgery annually in the United States. Results Six hundred thirty women were randomized to OE or OE plus UDS. There was no difference in surgical outcomes between the two groups. The per patient cost of UDS varied from site to site, and included complex cystometrogram $314-$343 (CPT codes 51728-51729) plus complex uroflowmetry $16 (CPT code 51741). Extrapolating these costs for US women similar to our study population, 13-33 million US dollars could be saved annually by not performing preoperative urodynamics. Conclusion For women with uncomplicated SUI and a confirmatory preoperative basic office evaluation, tens of millions of dollars US could be saved annually by not performing urodynamic testing. In the management of such women, eliminating this preoperative test has a major economic benefit.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 81-84 |
| Number of pages | 4 |
| Journal | Neurourology and Urodynamics |
| Volume | 35 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2016 |
Funding
Eric Rovner led the peer-review process as the Associate Editor responsible for the paper. Potential conflicts of interest: Gary Lemack has equity interests in Pfizer, has been a consultant for Allergan, has been a speaker for Allergan and Astellas, and has participated in a trial for Afferent. Stephen Kraus has been a consultant for Allergan and Pfizer, and has been a course director and part of a teaching faculty for Laborie Medical and Allergan. Larry Sirls has been a consultant for Johnson & Johnson, and has participated in trials for Cook and American Medical Systems. ClinicalTrials.gov ID Registration Number: NCT00803959. Grant sponsor: National Institute of Diabetes and Digestive and Kidney Diseases, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Grant numbers: U01 DK58225; U01 DK58229; U01 K58234; U01 DK58231; U01 DK60379; U01 DK60380; U01 DK60393; U01 DK60395; U01 K60397; U01DK60401 Correspondence to: Peggy A. Norton, M.D., Department of Obstetrics and Gynecology, University of Utah School of Medicine, 50 N Medical Drive, Salt Lake City, UT 84132. E-mail: [email protected] Received 18 May 2014; Accepted 2 September 2014 Published online 18 October 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.22684
Keywords
- cost of urodynamics
- urodynamics
ASJC Scopus subject areas
- Clinical Neurology
- Urology