Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence

被引:35
作者
Weber, AM [1 ]
Walters, MD [1 ]
机构
[1] Cleveland Clin Fdn, Dept Gynecol & Obstet, Cleveland, OH 44195 USA
关键词
cost-effectiveness analysis; intrinsic sphincteric deficiency; pelvic organ prolapse; stress urinary incontinence; urodynamic testing;
D O I
10.1067/mob.2000.111251
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: This study was undertaken to compare cost-effectiveness between 2 preoperative testing strategies for women with pelvic organ prolapse and stress urinary incontinence symptoms. STUDY DESIGN: We developed decision-analytic models that evaluated the cost-effectiveness of basic office evaluation before surgery in women with prolapse and stress urinary incontinence symptoms and contrasted ii with that of urodynamic testing. Costs were obtained from the Federal Register; effectiveness of treatment for urinary incontinence was based on the published literature. RESULTS: The strategies of basic office evaluation and urodynamic testing had the same cure rate of urinary incontinence (96%) after initial and secondary treatment. Under baseline assumptions incremental cost-effectiveness (cost for single extra cure of urinary incontinence) of urodynamic testing was $328,601. According to sensitivity analyses, basic office evaluation was more cost-effective than urodynamic testing when the prevalence of pure detrusor instability was <8% or when the cost of urodynamic testing was >$103. CONCLUSION: Urodynamic testing before surgery in women with prolapse and stress urinary incontinence symptoms is not cost-effective relative to basic office evaluation.
引用
收藏
页码:1338 / 1346
页数:9
相关论文
共 51 条
[1]  
Abrams P, 1990, INT UROGYNECOL J, V1, P45
[2]  
[Anonymous], 1996, AHCPR PUBLICATION
[3]   Primary slings for everyone with genuine stress incontinence? The Argument for ... [J].
R. A. Appell .
International Urogynecology Journal, 1998, 9 (5) :249-251
[4]   Urethral obstruction after anti-incontinence surgery in women: Evaluation, methodology, and surgical results [J].
Austin, P ;
Spyropoulos, E ;
Lotenfoe, R ;
Helal, M ;
Hoffman, M ;
Lockhart, JL .
UROLOGY, 1996, 47 (06) :890-894
[5]   Initial experience with the modified vaginal wall sling in the treatment of female stress urinary incontinence [J].
Batra A.K. ;
Mathews R. ;
Lopresti A. .
International Urogynecology Journal, 1997, 8 (4) :209-212
[6]  
BENT AE, 1990, INT UROGYNECOL J PEL, V1, P128
[7]   COMPARISON OF 3 DIFFERENT SURGICAL-PROCEDURES FOR GENUINE STRESS-INCONTINENCE - PROSPECTIVE RANDOMIZED STUDY [J].
BERGMAN, A ;
BALLARD, CA ;
KOONINGS, PP .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1989, 160 (05) :1102-1106
[8]   The effectiveness of surgery for stress incontinence in women: A systematic review [J].
Black, NA ;
Downs, SH .
BRITISH JOURNAL OF UROLOGY, 1996, 78 (04) :497-510
[9]   Voiding dysfunction following; Incontinence: Surgery: Diagnosis and treatment with retropubic or vaginal urethrolysis [J].
Carr, LK ;
Webster, GD .
JOURNAL OF UROLOGY, 1997, 157 (03) :821-823
[10]   The Burch colposuspension for women with and without detrusor overactivity [J].
Colombo, M ;
Zanetta, G ;
Vitobello, D ;
Milani, R .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1996, 103 (03) :255-260