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Cost-analysis of management strategies for children with vesico-ureteric reflux
1Department of Community Medicine, Lund University, Malmö, Sweden.
Insights
Subureteric injection is the most cost-effective treatment for pediatric vesico-ureteric reflux, followed by antibacterial prophylaxis. Neo-implantation is the most expensive option for treating this condition in children.
Area of Science:
- Pediatric Urology
- Health Economics
- Cost-Effectiveness Analysis
Background:
- Vesico-ureteric reflux (VUR) is a common condition in children, potentially leading to kidney infections and damage.
- Treatment options include surgical correction (neo-implantation, subureteric injection) and long-term medical management (antibacterial prophylaxis).
- Economic evaluations are crucial for comparing the cost-effectiveness of different VUR treatment strategies.
Purpose of the Study:
- To conduct an economic evaluation comparing three primary treatment strategies for pediatric vesico-ureteric reflux.
- To determine the cost-effectiveness of subureteric injection, antibacterial prophylaxis, and neo-implantation from a community perspective.
Main Methods:
- A cost-analysis approach was employed, focusing on direct and indirect costs.
- Data for surgical strategies were collected from four Swedish hospitals.
- Data for the prophylactic strategy were gathered via a survey of 31 hospitals.
Main Results:
- Subureteric injection was ranked as the most cost-effective strategy, with costs ranging from SEK 25,000-28,000 (SEK 26,000-36,000 for bilateral cases).
- Antibacterial prophylaxis was the second most cost-effective option (SEK 16,000-36,000).
- Neo-implantation presented the highest costs, ranging from SEK 65,000-90,000 (SEK 72,000-95,000 for bilateral cases).
Conclusions:
- Subureteric injection offers the most favorable economic profile for managing pediatric vesico-ureteric reflux.
- Antibacterial prophylaxis provides a moderate cost-effective alternative.
- Neo-implantation is significantly more costly compared to the other evaluated treatment modalities for VUR in children.
Abstract:
This study is an economic evaluation of three treatment strategies for vesico-ureteric reflux in children: neo-implantation; subureteric injection; and antibacterial prophylaxis. Cost-analysis was used to compare the strategies, implying that the differences in benefits between them were not measured. Direct and indirect costs are included, taking the analytical viewpoint of the community. For the surgical strategies, data from four different hospitals in Sweden were used, and for the prophylactic strategy, data was gathered through a survey of 31 hospitals. The treatment strategies were ranked in the following order (bilateral reflux in parentheses): (i) subureteric injection SEK 25,000-28,000 (26,000-36,000); (ii) antibacterial prophylaxis SEK 16,000-36,000; and (iii) neo-implantation SEK 65,000-90,000 (72,000-95,000).