Cost analysis of the treatment of vesicoureteral reflux: a computer model

Surgical intervention for vesicoureteral reflux is generally limited to children who have recurrent infection despite adequate antimicrobial prophylaxis or in whom compliance with followup cannot be ensured. In addition, surgical therapy is considered in children with persistent reflux after a reasonable period of surveillance. We used a model based on the management of a theoretical population of girls with various grades of reflux and followed the costs incurred during a 5-year management period.

The literature on vesicoureteral reflux was used to create a set of assumptions regarding epidemiology, likelihood of resolution, need for operative intervention, risk of infection and appropriate regimen for nonoperative surveillance. These parameters were evaluated in infants and children as noted in the literature. A 5-year management period was considered. Patients in whom reflux did not resolve with medical management at the end of 5 years were assumed to have undergone surgical correction. Costs were calculated based on the amounts billed, managed care reimbursement and Medicaid reimbursement in Maryland. The costs of up front surgical management were calculated and compared to those of 5 years of standard management. All costs were discounted at a rate of 10%.

Calculated costs of standard management were lower for lower grades than those for higher grades of reflux. The costs of surgical management were lower than those of standard management for higher reflux grades using nondiscounted costs. However, when costs were discounted to present value, the costs of standard management were significantly lower than those of up-front surgery for all scenarios studied.

The cost of vesicoureteral reflux is considerable when whole patient groups are considered. Using cost as the only parameter the standard management of reflux is less costly than up-front surgery. In the individual surgical intervention usually is predicated by patient and family factors which were not considered in this model. This computer based construct allows data from different institutions to be analyzed to project costs of the management of reflux.