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07.01.2023 | Urology - Original Paper

Cost-effectiveness of routine type and screens in select urological surgeries

verfasst von: Joshua Volin, Joshua Daniel, Brianna Walter, Patrick Herndon, Deanna Tran, James Blumline, Aviv Spillinger, Patrick Karabon, Craig Fletcher, Adam Folbe, Jason Hafron

Erschienen in: International Urology and Nephrology | Ausgabe 4/2023

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Abstract

Purpose

To evaluate the cost-effectiveness of obtaining a preoperative type and screen (T/S) for common urologic procedures.

Methods

A decision tree model was constructed to track surgical patients undergoing two preoperative blood ordering strategies as follows: obtaining a preoperative T/S versus not doing so. The model was applied to the National (Nationwide) Inpatient Sample (NIS) data, from January 1, 2006 to September 30, 2015. Cost estimates for the model were created from combined patient-level data with published costs of a T/S, type and crossmatch (T/C), a unit of pRBC, and one unit of emergency-release transfusion (ERT). The primary outcome was the incremental cost per ERT prevented, expressed as an incremental cost-effectiveness ratio (ICER) between the two preoperative blood ordering strategies. A cost-effectiveness analysis determined the ICER of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.00.

Results

A total of 4,113,144 surgical admissions from 2006 to 2015 were reviewed. The overall transfusion rate was 10.54% (95% CI, 10.17–10.91) for all procedures. The ICER of preoperative T/S was $1500.00 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S.

Conclusion

Routine preoperative T/S for radical prostatectomy (rate = 3.88%) and penile implants (rate = .91%) does not represent a cost-effective practice for these surgeries. It is important for urologists to review their institution T/S policy to reduce inefficiencies within the preoperative setting.

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Titel: Cost-effectiveness of routine type and screens in select urological surgeries
verfasst von: Joshua Volin
Joshua Daniel
Brianna Walter
Patrick Herndon
Deanna Tran
James Blumline
Aviv Spillinger
Patrick Karabon
Craig Fletcher
Adam Folbe
Jason Hafron
Publikationsdatum: 07.01.2023
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 4/2023
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-022-03452-6

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