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Decision Analysis Model Comparing Cost of Management Strategies for Pelvic Fracture Urethral Injuries
Timothy J Tausch1, Yair Lotan1, Lee Zhao1
1Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Urology Practice
|August 18, 2023
Summary
Delayed urethroplasty after pelvic fracture urethral injuries is more cost-effective than primary endoscopic realignment. This approach saves $1,300 per patient, offering a durable and economical treatment for urethral trauma.
Area of Science:
- Urology
- Trauma Surgery
- Health Economics
Background:
- Pelvic fracture urethral injuries require management strategies balancing cost and efficacy.
- Initial management often involves suprapubic tubes, with subsequent reconstructive options debated.
Purpose of the Study:
- To compare the cost-effectiveness of primary endoscopic realignment versus delayed bulbomembranous anastomotic urethroplasty for pelvic fracture urethral injuries.
- To determine the cost savings associated with each management approach.
Main Methods:
- Decision analysis model comparing costs of primary endoscopic realignment and delayed urethroplasty after suprapubic tube placement.
- Literature review for success rates (30% primary realignment, 92% urethroplasty, 50% internal urethrotomy).
- Cost estimation using institutional data and Medicare reimbursement; sensitivity analyses performed.
Main Results:
- Delayed bulbomembranous urethroplasty with suprapubic tube placement costs $9,743, compared to $11,043 for primary endoscopic realignment, a 12% cost saving ($1,300/patient).
- Primary endoscopic realignment requires a 40% success rate to be preferred.
- Bulbomembranous urethroplasty efficacy of 78% or greater makes it more cost-effective.
Conclusions:
- Delayed, definitive urethroplasty is a cost-effective strategy for managing pelvic fracture urethral injuries.
- Primary endoscopic realignment presents higher costs and variable outcomes.
- The durability of urethroplasty supports its economic advantage in treating male urethral trauma.
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