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The effect of dysfunctional voiding on the costs of treating vesicoureteral reflux: a computer model
Ronald M Benoit1, Barbara V Wise, Michael J Naslund
1Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Insights
Dysfunctional voiding significantly increases treatment costs for pediatric vesicoureteral reflux (VUR) by over 50%. Addressing urinary tract infections in these children could save substantial healthcare costs.
Area of Science:
- Pediatric Urology
- Health Economics
- Medical Modeling
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Dysfunctional voiding (DV) is a known factor influencing VUR management.
- The economic impact of DV on VUR treatment costs requires detailed evaluation.
Purpose of the Study:
- To develop a computer model to assess the economic impact of DV on the management costs of pediatric VUR.
- To compare the treatment costs of VUR in children with and without DV over a 5-year period.
Main Methods:
- Literature review to establish epidemiological and management assumptions for VUR.
- Inclusion of recent literature on the effect of DV on VUR clinical course.
- Development of a comparative cost-effectiveness model for VUR management in children with and without DV.
Main Results:
- DV increased VUR treatment costs by 51.2% per patient.
- Cost differences between VUR with and without DV widened with increasing reflux grade (18.7% to 62.1%).
- Sensitivity analysis confirmed higher costs in children with DV across various scenarios, demonstrating model robustness.
Conclusions:
- DV significantly elevates VUR treatment costs in children, primarily due to increased urinary tract infection (UTI) rates.
- Interventions reducing UTI incidence in children with VUR and DV could yield significant healthcare savings.
- Targeting DV management is crucial for cost-effective VUR treatment in pediatric populations.
Purpose:
We created a computer model for evaluating the effect of dysfunctional voiding on the costs of managing vesicoureteral reflux in children.
Materials And Methods:
The literature on vesicoureteral reflux was reviewed to create a set of assumptions regarding the epidemiology, likelihood of resolution, need for operative intervention, risk of infection and appropriate regimen for nonoperative surveillance. Recent literature describing the effect of dysfunctional voiding on the clinical course of vesicoureteral reflux was included in the model to compare the costs of treating vesicoureteral reflux in children with and without dysfunctional voiding. A 5-year management period was considered.
Results:
Dysfunctional voiding in children with vesicoureteral reflux increased the cost of treatment per patient by 51.2%. The cost per patient increased with increasing grade in those with and without dysfunctional voiding. The difference in costs in the 2 groups increased from 18.7% for grade 1 reflux to 62.1% for grade 5. Sensitivity analysis was performed, in which the risk of urinary tract infection, rate of surgical resolution, incidence of dysfunctional voiding and discount rate varied. The cost in children with dysfunctional voiding remained higher in all scenarios studied, showing the robustness of the model.
Conclusions:
Dysfunctional voiding substantially increases the costs of treating children with vesicoureteral reflux due to the higher rate of urinary tract infection in children with dysfunctional voiding. Methods that would decrease the rate of urinary tract infection in children with dysfunctional voiding and vesicoureteral reflux would lead to a significant saving of health care dollars.
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