A Cost-Effectiveness Analysis of Post-Void Residual Bladder Scan Thresholds in the Postoperative Setting

Area of Science:

• Urogynecology
• Health Economics
• Medical Technology Assessment

Background:

• Postoperative urinary retention (POUR) is a common complication after urogynecologic procedures.
• Accurate and cost-effective methods for monitoring bladder function are crucial for patient management.
• Bladder scan post-void residual (PVR) measurements are frequently used, but optimal thresholds require definition.

Purpose of the Study:

• To determine the optimal cost-effectiveness threshold for post-void residual (PVR) bladder scan volumes in patients undergoing urogynecologic surgery.
• To analyze the economic impact of different PVR thresholds on healthcare resource utilization.

Main Methods:

• A cost-effectiveness analysis was conducted using data from a prior study of 151 patients.
• Scenarios modeled ambulatory office and emergency department (ED) resource utilization for PVR thresholds of 100 ml, 150 ml, and 200 ml.
• Quality-adjusted life years (QALYs) and direct medical costs were used to calculate the incremental cost-effectiveness ratio (ICER), assuming a $100,000 per QALY willingness-to-pay threshold.

Main Results:

• A PVR threshold of 100 ml was not cost-effective, exceeding the willingness-to-pay threshold.
• A PVR threshold of 150 ml was found to be dominant, significantly reducing costs and ED visits for POUR.
• A PVR threshold of 200 ml was cost-effective but associated with increased ED utilization and under-detection of POUR.

Conclusions:

• A 100 ml PVR threshold imposes a healthcare system burden due to excessive clinic visits.
• Both 150 ml and 200 ml PVR thresholds are cost-effective, but 150 ml minimizes ED visits and under-detection of POUR.
• A 150 ml PVR cut-off represents the most cost-effective strategy for managing postoperative bladder function in urogynecologic patients.