Cost-effectiveness of bacteriuria screening before urogynecologic surgery

Area of Science:

• Urogynecology
• Infectious Disease Prevention
• Health Economics

Background:

• Controversy exists regarding preoperative bacteriuria screening for urogynecologic surgery patients.
• Uncertainty surrounds the benefit of treating asymptomatic bacteriuria in reducing postoperative urinary tract infections (UTIs).

Purpose of the Study:

• To determine the most cost-effective strategy for preoperative bacteriuria screening in women undergoing urogynecologic surgery.
• Evaluate universal, selective, and no-screening protocols for preventing postoperative UTIs.

Main Methods:

• A decision tree model assessed cost-effectiveness from a societal perspective.
• Compared universal screening, selective screening (for recurrent UTIs), and no screening.
• Primary outcome: incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY).

Main Results:

• Selective screening was more effective and cost-effective than no screening (ICER: $49,349/QALY).
• Universal screening was dominated by both selective and no-screening strategies (less effective, more costly).
• Sensitivity analyses identified thresholds for selective screening's cost-effectiveness.

Conclusions:

• Selective preoperative bacteriuria screening is generally cost-effective for urogynecologic surgery.
• This strategy results in a minimal increase (<1%) in 30-day postoperative UTIs.
• No screening is cost-effective under specific conditions of high UTI costs and low asymptomatic bacteriuria rates.