Skip to main content
Erschienen in:

17.01.2022 | Original Article

A Cost-Effectiveness Analysis of Post-Void Residual Bladder Scan Thresholds in the Postoperative Setting

verfasst von: Katelyn Donaldson, Abbigail Woll, Sierra M. Jansen, Autumn Edenfield, Steven Swift, Christine A. Heisler

Erschienen in: International Urogynecology Journal | Ausgabe 10/2022

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

To identify the optimal cost-effectiveness threshold of post-void residual (PVR) by bladder scan in postoperative urogynecologic patients.

Methods

A cost-effectiveness analysis was performed as a secondary analysis of a previously published study of patients undergoing urogynecologic procedures with planned voiding trials, setting thresholds for postoperative PVR bladder scan volumes at 100 ml, 150 ml, and 200 ml. Patient-based scenarios were modeled for ambulatory office or emergency department (ED) resource utilization and to determine the cost-effectiveness of each threshold. Costs were obtained from a southeastern academic medical center, only utilizing direct medical costs and hospital costs, not including societal costs. Quality-adjusted life years (QALY’s) were used as health outcomes determining the incremental cost-effectiveness ratio (ICER).

Results

A total of 151 patients from the original study were included. A willingness to pay threshold of $100,000 per QALY was assumed. A PVR of 100 ml exceeded this at $373,824. A PVR threshold of 150 ml was dominant (-$1,211,716), while minimizing ED visits for postoperative urinary retention (POUR) and unnecessary clinic appointments. While a PVR of 200 ml appeared a cost-effective strategy (-$488,389), there was increased ED utilization and under-detection of postoperative urinary retention (POUR).

Conclusion

A PVR threshold of 100 ml created a healthcare system burden due to increased office voiding trials. Both PVR thresholds of 150 ml and 200 ml were cost-effective strategies; however, ED utilization for POUR increased with 200 ml. Utilizing 150 ml as the PVR cut-off proved the most cost-effective strategy, avoiding POUR under-detection and undue health costs.
Literatur
1.
Zurück zum Zitat Katz EG, Stensland KD, Alazem K, et al. The role of perioperative medications in urinary retention following midurethral sling. Neurourol Urodyn. 2020;39:2455–62.CrossRef Katz EG, Stensland KD, Alazem K, et al. The role of perioperative medications in urinary retention following midurethral sling. Neurourol Urodyn. 2020;39:2455–62.CrossRef
2.
Zurück zum Zitat Elshatanoufy S, Matthews A, Yousif M, et al. Effect of morbid obesity on midurethral sling efficacy for the management of stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2019;25:448–52.CrossRef Elshatanoufy S, Matthews A, Yousif M, et al. Effect of morbid obesity on midurethral sling efficacy for the management of stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2019;25:448–52.CrossRef
3.
Zurück zum Zitat Propst K, O’Sullivan DM, Tulikangas PK. Transdermal scopolamine and acute postoperative urinary retention in pelvic reconstructive surgery. Female Pelvic Medicine & Reconstructive Surgery. 2016;22:328–31.CrossRef Propst K, O’Sullivan DM, Tulikangas PK. Transdermal scopolamine and acute postoperative urinary retention in pelvic reconstructive surgery. Female Pelvic Medicine & Reconstructive Surgery. 2016;22:328–31.CrossRef
4.
Zurück zum Zitat Dörflinger A, Monga A. Voiding dysfunction. Curr Opin Obstet Gynecol. 2001;13:507–12.CrossRef Dörflinger A, Monga A. Voiding dysfunction. Curr Opin Obstet Gynecol. 2001;13:507–12.CrossRef
5.
Zurück zum Zitat Partoll LM. Efficacy of tension-free vaginal tape with other pelvic reconstructive surgery. American Journal of Obstetrics and Gynecology. 2002;186:1292–5 discussion 5-8.CrossRef Partoll LM. Efficacy of tension-free vaginal tape with other pelvic reconstructive surgery. American Journal of Obstetrics and Gynecology. 2002;186:1292–5 discussion 5-8.CrossRef
6.
Zurück zum Zitat Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014;6:829–38.CrossRef Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014;6:829–38.CrossRef
7.
Zurück zum Zitat Sanders GD, Maciejewski ML, Basu A. Overview of cost-effectiveness analysis. JAMA. 2019;321:1400–1.CrossRef Sanders GD, Maciejewski ML, Basu A. Overview of cost-effectiveness analysis. JAMA. 2019;321:1400–1.CrossRef
8.
Zurück zum Zitat Kesty K, Edenfield A, Castro D, et al. Subjective versus objective determination of bladder emptying following urogynecological surgery: “do you feel that you completely emptied your bladder?” Int Urogynecol J. 2020;31:1899–905.CrossRef Kesty K, Edenfield A, Castro D, et al. Subjective versus objective determination of bladder emptying following urogynecological surgery: “do you feel that you completely emptied your bladder?” Int Urogynecol J. 2020;31:1899–905.CrossRef
9.
Zurück zum Zitat Jansen SM, Woll A, Brown HW, Swift S, Edenfield A, Zhou Q, Heisler CA. Can We Trust the Math? Correlation of Objective Postvoid Residual With Calculated Subtraction Postvoid Residual. Female Pelvic Med Reconstr Surg. 2022 Jan 1;28(1):45–48. Jansen SM, Woll A, Brown HW, Swift S, Edenfield A, Zhou Q, Heisler CA. Can We Trust the Math? Correlation of Objective Postvoid Residual With Calculated Subtraction Postvoid Residual. Female Pelvic Med Reconstr Surg. 2022 Jan 1;28(1):45–48.
10.
Zurück zum Zitat Garcia-Gordillo MA, Collado-Mateo D, Olivares PR, et al. Application of EQ-5D-5L questionnaire in patients suffering from urinary incontinence. Actas Urol Esp. 2016;40:457–62.CrossRef Garcia-Gordillo MA, Collado-Mateo D, Olivares PR, et al. Application of EQ-5D-5L questionnaire in patients suffering from urinary incontinence. Actas Urol Esp. 2016;40:457–62.CrossRef
11.
Zurück zum Zitat Desroziers K, Aballéa S, Maman K, et al. Estimating EQ-5D and OAB-5D health state utilities for patients with overactive bladder. Health Qual Life Outcomes. 2013;11:200.CrossRef Desroziers K, Aballéa S, Maman K, et al. Estimating EQ-5D and OAB-5D health state utilities for patients with overactive bladder. Health Qual Life Outcomes. 2013;11:200.CrossRef
12.
Zurück zum Zitat Harvie HS, Shea JA, Andy UU, et al. Validity of utility measures for women with urge, stress, and mixed urinary incontinence. American Journal of Obstetrics and Fynecology. 2014;210(85):e1-6. Harvie HS, Shea JA, Andy UU, et al. Validity of utility measures for women with urge, stress, and mixed urinary incontinence. American Journal of Obstetrics and Fynecology. 2014;210(85):e1-6.
13.
Zurück zum Zitat Averbeck MA, Krassioukov A, Thiruchelvam N, et al. The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey. J Med Econ. 2018;21:945–52.CrossRef Averbeck MA, Krassioukov A, Thiruchelvam N, et al. The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey. J Med Econ. 2018;21:945–52.CrossRef
14.
Zurück zum Zitat Arnold MW, Stewart WR, Aguilar PS. Rectocele repair. Four years’ experience. Diseases of the Colon and Rectum. 1990;33:684–7.CrossRef Arnold MW, Stewart WR, Aguilar PS. Rectocele repair. Four years’ experience. Diseases of the Colon and Rectum. 1990;33:684–7.CrossRef
15.
Zurück zum Zitat Book NM, Novi B, Novi JM, et al. Postoperative voiding dysfunction following posterior colporrhaphy. Female Pelvic Med Reconstr Surg. 2012;18:32–4.CrossRef Book NM, Novi B, Novi JM, et al. Postoperative voiding dysfunction following posterior colporrhaphy. Female Pelvic Med Reconstr Surg. 2012;18:32–4.CrossRef
16.
Zurück zum Zitat Turner LC, Kantartzis K, Shepherd JP. Predictors of postoperative acute urinary retention in women undergoing minimally invasive sacral colpopexy. Female Pelvic Med Reconstr Surg. 2015;21:39–42.CrossRef Turner LC, Kantartzis K, Shepherd JP. Predictors of postoperative acute urinary retention in women undergoing minimally invasive sacral colpopexy. Female Pelvic Med Reconstr Surg. 2015;21:39–42.CrossRef
17.
Zurück zum Zitat Hakvoort RA, Dijkgraaf MG, Burger MP, et al. Predicting short-term urinary retention after vaginal prolapse surgery. Neurourol Urodyn. 2009;28:225–8.CrossRef Hakvoort RA, Dijkgraaf MG, Burger MP, et al. Predicting short-term urinary retention after vaginal prolapse surgery. Neurourol Urodyn. 2009;28:225–8.CrossRef
18.
Zurück zum Zitat Yune JJ, Cheng JW, Wagner H, et al. Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach. Neurourol Urodyn. 2018;37:1794–800.CrossRef Yune JJ, Cheng JW, Wagner H, et al. Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach. Neurourol Urodyn. 2018;37:1794–800.CrossRef
Metadaten
Titel
A Cost-Effectiveness Analysis of Post-Void Residual Bladder Scan Thresholds in the Postoperative Setting
verfasst von
Katelyn Donaldson
Abbigail Woll
Sierra M. Jansen
Autumn Edenfield
Steven Swift
Christine A. Heisler
Publikationsdatum
17.01.2022
Verlag
Springer International Publishing
Erschienen in
International Urogynecology Journal / Ausgabe 10/2022
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-021-05065-6

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Automatisierte Insulinabgabe hilft postpartal bei Blutzuckerkontrolle

Ergebnisse aus einer Fortsetzung der AiDAPT-Studie sprechen dafür, dass ein HCL („hybrid closed loop“)-System auch in den ersten sechs Monaten nach dem Entbinden eine bessere Blutzuckereinstellung erlaubt als eine Standardinsulinabgabe.  

cfDNA-Screening kann auf maternalen Krebs hinweisen

Unübliche oder nicht auswertbare Resultate des nichtinvasiven Screenings auf fetale Aneuploidie mithilfe der Sequenzierung zellfreier DNA können ein Zeichen für Krebs der Mutter sein. In einer Studie lag die Prävalenz nahe 50%.

Rate der Totgeburten in Deutschland ist gestiegen

Die Rate von Totgeburten hat sich in den europäischen Ländern in den vergangenen Jahren unterschiedlich entwickelt. In Deutschland ist sie gestiegen und liegt über dem Durchschnitt. Eine Forschungsgruppe hat nach den Gründen gesucht.

Präeklampsie wohl wichtiger Risikofaktor für schwere maternale Morbidität

Bei Schwangeren mit unkomplizierter chronischer Hypertonie kann die Prävention der Präeklampsie möglicherweise das Risiko für schwere mütterliche Morbidität auf ein Niveau senken, das mit dem von Patientinnen mit normalem Blutdruck vergleichbar ist.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.