Diagnostic and Cost Implications of the 2020 AUA Microhematuria Guidelines : Modeling Impact in a Large Public Health Care System
PURPOSE: We sought to model the diagnostic recommendations and associated costs of new hematuria guidelines regarding referral patterns, procedure utilization and urothelial cell carcinoma (UCC) detection.
MATERIALS AND METHODS: Patients with microhematuria were identified retrospectively. Initial encounter data were collected from January 2017 to May 2018 from a large public health care system; followup was continued to December 2020. Risk stratification was performed based on the American Urological Association 2020 microhematuria guidelines, and disease outcomes were analyzed within this framework. The guideline-recommended workups and costs were modeled; cost data were sourced from the Centers for Medicare & Medicaid Services Medicare Physician Fee Schedule and Clinical Laboratory Fee Schedule for 2020. Modeled diagnostic volumes and costs were assessed for 2020 and 2012 microhematuria guidelines, respectively.
RESULTS: Of the 3,789 patients included for analysis, 1,382 (36.5%), 1,026 (27.1%) and 1,381 (36.4%) were retroactively stratified as low risk, intermediate risk (InR) and high risk (HiR), respectively. A total of 19 cases of UCC (17 bladder, 2 upper tract) were diagnosed, of which 84% were HiR. For high-grade UCC, 92% of cases were HiR. The 2020 guidelines recommended renal ultrasound for 1,117 InR cases, computerized tomography urogram (CTU) for 1,476 HiR cases, and cystoscopy for 2,593 InR and HiR cases combined. Total costs were $1,905,236 (2012) versus $1,260,677 (2020), driven mainly by CTU costs. Per-cancer detected costs were $100,276 (2012) versus $61,760 (2020).
CONCLUSIONS: In retrospect, the 2020 guidelines would have effectively risk-stratified microhematuria cases for detection of malignancies. As compared to the 2012 guidelines, application of the 2020 guidelines would result in significant changes to diagnostic and procedural volumes, while substantially reducing total and per-patient costs.
| Errataetall: | |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:207 |
|---|---|
| Enthalten in: |
The Journal of urology - 207(2022), 1 vom: 25. Jan., Seite 52-60 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Gold, Samuel A [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Costs and cost analysis |
|---|
| Anmerkungen: |
Date Completed 20.01.2022 Date Revised 28.04.2022 published: Print-Electronic CommentIn: J Urol. 2022 Jan;207(1):59-60. - PMID 34583516 Citation Status MEDLINE |
|---|
| doi: |
10.1097/JU.0000000000002175 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM329721593 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM329721593 | ||
| 003 | DE-627 | ||
| 005 | 20231225205732.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/JU.0000000000002175 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1099.xml |
| 035 | |a (DE-627)NLM329721593 | ||
| 035 | |a (NLM)34428924 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Gold, Samuel A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Diagnostic and Cost Implications of the 2020 AUA Microhematuria Guidelines |b Modeling Impact in a Large Public Health Care System |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.01.2022 | ||
| 500 | |a Date Revised 28.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Urol. 2022 Jan;207(1):59-60. - PMID 34583516 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: We sought to model the diagnostic recommendations and associated costs of new hematuria guidelines regarding referral patterns, procedure utilization and urothelial cell carcinoma (UCC) detection | ||
| 520 | |a MATERIALS AND METHODS: Patients with microhematuria were identified retrospectively. Initial encounter data were collected from January 2017 to May 2018 from a large public health care system; followup was continued to December 2020. Risk stratification was performed based on the American Urological Association 2020 microhematuria guidelines, and disease outcomes were analyzed within this framework. The guideline-recommended workups and costs were modeled; cost data were sourced from the Centers for Medicare & Medicaid Services Medicare Physician Fee Schedule and Clinical Laboratory Fee Schedule for 2020. Modeled diagnostic volumes and costs were assessed for 2020 and 2012 microhematuria guidelines, respectively | ||
| 520 | |a RESULTS: Of the 3,789 patients included for analysis, 1,382 (36.5%), 1,026 (27.1%) and 1,381 (36.4%) were retroactively stratified as low risk, intermediate risk (InR) and high risk (HiR), respectively. A total of 19 cases of UCC (17 bladder, 2 upper tract) were diagnosed, of which 84% were HiR. For high-grade UCC, 92% of cases were HiR. The 2020 guidelines recommended renal ultrasound for 1,117 InR cases, computerized tomography urogram (CTU) for 1,476 HiR cases, and cystoscopy for 2,593 InR and HiR cases combined. Total costs were $1,905,236 (2012) versus $1,260,677 (2020), driven mainly by CTU costs. Per-cancer detected costs were $100,276 (2012) versus $61,760 (2020) | ||
| 520 | |a CONCLUSIONS: In retrospect, the 2020 guidelines would have effectively risk-stratified microhematuria cases for detection of malignancies. As compared to the 2012 guidelines, application of the 2020 guidelines would result in significant changes to diagnostic and procedural volumes, while substantially reducing total and per-patient costs | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a costs and cost analysis | |
| 650 | 4 | |a hematuria | |
| 650 | 4 | |a practice guidelines as topic | |
| 650 | 4 | |a urinary bladder neoplasms | |
| 700 | 1 | |a Kenigsberg, Alexander P |e verfasserin |4 aut | |
| 700 | 1 | |a Lotan, Yair |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Journal of urology |d 1945 |g 207(2022), 1 vom: 25. Jan., Seite 52-60 |w (DE-627)NLM000006890 |x 1527-3792 |7 nnns |
| 773 | 1 | 8 | |g volume:207 |g year:2022 |g number:1 |g day:25 |g month:01 |g pages:52-60 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/JU.0000000000002175 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 207 |j 2022 |e 1 |b 25 |c 01 |h 52-60 | ||