The cost of preoperative urodynamics

A secondary analysis of the ValUE trial

Peggy A. Norton, Charles W. Nager, Linda Brubaker, Gary E. Lemack, Larry T. Sirls, Robert Holley, Toby C. Chai, Stephen R. Kraus, Halina Zyczynski, Bridget Smith, Anne Stoddard

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Aims Urodynamic studies (UDS) are generally recommended prior to surgical treatment for stress urinary incontinence (SUI), despite insufficient evidence that it impacts treatment plans or outcomes in patients with uncomplicated SUI. This analysis aimed to calculate the cost incurred when UDS was performed as a supplement to a basic office evaluation and to extrapolate the potential savings of not doing UDS in this patient population on a national basis. Methods This is a secondary analysis from the Value of Urodynamic Evaluation (ValUE) trial, a multicenter non-inferiority randomized trial to determine whether a basic office evaluation (OE) is non-inferior in terms of SUI surgery outcomes to office evaluation with addition of urodynamic studies (UDS). All participants underwent an OE; those patients who randomized to supplementary UDS underwent non-instrumented uroflowmetry, filling cystometry, and a pressure flow study. Costs associated with UDS were calculated using 2014 U.S. Medicare allowable fees. Models using various patient populations and payor mixes were created to obtain a range of potential costs of performing UDS in patients undergoing SUI surgery annually in the United States. Results Six hundred thirty women were randomized to OE or OE plus UDS. There was no difference in surgical outcomes between the two groups. The per patient cost of UDS varied from site to site, and included complex cystometrogram $314-$343 (CPT codes 51728-51729) plus complex uroflowmetry $16 (CPT code 51741). Extrapolating these costs for US women similar to our study population, 13-33 million US dollars could be saved annually by not performing preoperative urodynamics. Conclusion For women with uncomplicated SUI and a confirmatory preoperative basic office evaluation, tens of millions of dollars US could be saved annually by not performing urodynamic testing. In the management of such women, eliminating this preoperative test has a major economic benefit.

Original languageEnglish (US)
Pages (from-to)81-84
Number of pages4
JournalNeurourology and Urodynamics
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2016

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Urodynamics
Costs and Cost Analysis
Stress Urinary Incontinence
Current Procedural Terminology
Population
Fees and Charges
Medicare
Multicenter Studies
Economics

Keywords

  • cost of urodynamics
  • urodynamics

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology

Cite this

Norton, P. A., Nager, C. W., Brubaker, L., Lemack, G. E., Sirls, L. T., Holley, R., ... Stoddard, A. (2016). The cost of preoperative urodynamics: A secondary analysis of the ValUE trial. Neurourology and Urodynamics, 35(1), 81-84. https://doi.org/10.1002/nau.22684

The cost of preoperative urodynamics : A secondary analysis of the ValUE trial. / Norton, Peggy A.; Nager, Charles W.; Brubaker, Linda; Lemack, Gary E.; Sirls, Larry T.; Holley, Robert; Chai, Toby C.; Kraus, Stephen R.; Zyczynski, Halina; Smith, Bridget; Stoddard, Anne.

In: Neurourology and Urodynamics, Vol. 35, No. 1, 01.01.2016, p. 81-84.

Research output: Contribution to journalArticle

Norton, PA, Nager, CW, Brubaker, L, Lemack, GE, Sirls, LT, Holley, R, Chai, TC, Kraus, SR, Zyczynski, H, Smith, B & Stoddard, A 2016, 'The cost of preoperative urodynamics: A secondary analysis of the ValUE trial', Neurourology and Urodynamics, vol. 35, no. 1, pp. 81-84. https://doi.org/10.1002/nau.22684
Norton, Peggy A. ; Nager, Charles W. ; Brubaker, Linda ; Lemack, Gary E. ; Sirls, Larry T. ; Holley, Robert ; Chai, Toby C. ; Kraus, Stephen R. ; Zyczynski, Halina ; Smith, Bridget ; Stoddard, Anne. / The cost of preoperative urodynamics : A secondary analysis of the ValUE trial. In: Neurourology and Urodynamics. 2016 ; Vol. 35, No. 1. pp. 81-84.
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