Original ArticleCost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy
Section snippets
Materials and Methods
A decision tree from a US healthcare payer perspective was used to model the possible outcomes and complications of laparoscopic hysterectomy, incorporating intraoperative and delayed recognition of LUTI, complications of cystoscopy, and expected rates of postoperative complications in the absence of any LUTI. The usual care branch served as the base case because hysterectomy without the possibility of cystoscopy does not meet the standard of care. The usual care model is summarized in Fig. 1;
Results
On the basis of our model, the estimated total direct medical costs of laparoscopic hysterectomy under the usual care paradigm ranged from $8831 to $9149 across the range of possible LUTI rates (Table 1). Under the same LUTI rates, the implementation of universal cystoscopy cost was estimated at $8944 to $9068. When low overall LUTI rates were assumed, universal cystoscopy was not estimated to be cost-effective or cost-saving. The incremental costs of universal cystoscopy ranged between $111
Discussion
Although many have called for routine cystoscopy at the time of benign laparoscopic hysterectomy, data supporting its efficacy are limited. In this paper, we have presented a novel decision analytic framework demonstrating that universal cystoscopy is likely cost-effective when assuming contemporary reported rates of LUTI and possibly cost-saving at higher LUTI rates.
There is significant discrepancy in the reported rates of LUTI at the time of hysterectomy within the published literature [2,4,6,
Acknowledgments
We would like to thank Ashish Premkumar for his thoughtful editing and review of this manuscript.
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Kimberly Kenton has received grant funding from Boston Scientific and serves as an expert witness for Ethicon. Margaret G. Mueller serves as an expert witness for Ethicon. The other authors declare that they have no conflict of interest.
The results from the cost estimates were presented as a nonoral poster at the virtual 2020 Society for Gynecologic Surgeons Meeting on July 9-12, 2020.
This study was approved as exempt by the Northwestern University Institutional Review Board (STU00210930).