PMID: 11339916May 8, 2001Paper

Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy

Obstetrics and Gynecology
A G ViscoE R Myers

Abstract

To evaluate the cost-effectiveness of routine cystoscopy at the time of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy in terms of cost per ureteral injury identified and treated. Using a hospital-based perspective, a decision-analysis model was constructed to estimate the outcomes and costs of cystoscopy or no cystoscopy at the time of abdominal hysterectomy. A similar model was constructed for vaginal and laparoscopically assisted vaginal hysterectomy to account for the cost of conversion to laparotomy. Cost estimates were based on estimated costs of Duke University Medical Center and from average Medicare reimbursements for similar Diagnostic Related Groups from the Health Care Financing Administration. The incidence of ureteral injury was obtained from a review of the literature. Sensitivity analyses were performed for the following variables: ureteral injury rate, silent ureteral injury rate, cost of cystoscopy, and cost of therapeutic interventions. We assumed a silent renal death rate of 0%. Routine cystoscopy at abdominal hysterectomy was cost-saving above a threshold ureteral injury rate of 1.5%. At a ureteral injury rate of 0.2%, the marginal increase in the cost of routine intraoperative cysto...Continue Reading

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Citations

Dec 1, 2005·International Urogynecology Journal and Pelvic Floor Dysfunction·Ja-Hong KimSandip Vasavada
Jan 24, 2009·International Urogynecology Journal and Pelvic Floor Dysfunction·Mou-Tsy ChouRay-Chang Lien
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Jun 30, 2005·Best Practice & Research. Clinical Obstetrics & Gynaecology·Ray Garry
Feb 5, 2013·Best Practice & Research. Clinical Obstetrics & Gynaecology·Senem Ates, Togas Tulandi
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Jul 23, 2009·Current Opinion in Obstetrics & Gynecology·Hiren Patel, Narender Bhatia
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