Gettman Matthew T, Lotan Yair, Roerhborn Claus G, Cadeddu Jeffrey A, Pearle Margaret S
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Urol. 2003 Jan;169(1):228-32. doi: 10.1016/S0022-5347(05)64074-8.
We determined the optimal treatment for primary ureteropelvic junction obstruction based on cost using a decision tree model.
A comprehensive literature search for articles addressing surgical correction of ureteropelvic junction obstruction was performed and data were abstracted on operative time, hospital stay, complications and success rate. The overall cost and individual cost centers at our institution for antegrade endopyelotomy, retrograde ureteroscopic endopyelotomy, Acucise (Applied Medical Resources, Laguna Hills, California) endopyelotomy, laparoscopic pyeloplasty and open pyeloplasty were compared. A decision tree model estimated the cost of treatment and followup for each modality using commercially available software. Sensitivity analyses were performed to evaluate the effect of individual treatment variables on overall cost.
Based on cost center review retrograde ureteroscopic endopyelotomy was the least costly procedure ($2,891). In the decision tree model the rank order of overall treatment costs was: retrograde ureteroscopic endopyelotomy ($3,842), Acucise endopyelotomy ($4,427), antegrade endopyelotomy ($5,297), laparoscopic pyeloplasty ($7,026) and open pyeloplasty ($7,119). Despite various hospital stay, operative time, equipment cost and success rate data 1-way sensitivity analysis revealed that antegrade endopyelotomy, laparoscopic pyeloplasty and open pyeloplasty were never cost effective compared with retrograde ureteroscopic endopyelotomy or Acucise endopyelotomy, while 2-way sensitivity analysis favored retrograde ureteroscopic endopyelotomy.
Primary cost variables for ureteropelvic junction obstruction treatments include operative time, hospital stay, equipment cost and success rate. Decision tree analysis showed that retrograde ureteroscopic or Acucise endopyelotomy is the most cost-effective treatment modality at our institution. However, cost is only 1 of a number of factors that are considered when deciding on an optimal course of treatment.
我们使用决策树模型，基于成本确定原发性输尿管肾盂连接部梗阻的最佳治疗方法。
全面检索关于输尿管肾盂连接部梗阻手术矫正的文章，并提取手术时间、住院时间、并发症及成功率的数据。比较了我们机构顺行肾盂内切开术、逆行输尿管镜肾盂内切开术、Acucise（应用医疗资源公司，加利福尼亚州拉古纳希尔斯）肾盂内切开术、腹腔镜肾盂成形术及开放肾盂成形术的总成本及各个成本中心。使用商用软件，通过决策树模型估算每种治疗方式的治疗及随访成本。进行敏感性分析以评估各个治疗变量对总成本的影响。
基于成本中心评估，逆行输尿管镜肾盂内切开术是成本最低的手术（2891美元）。在决策树模型中，总体治疗成本的排序为：逆行输尿管镜肾盂内切开术（3842美元）、Acucise肾盂内切开术（4427美元）、顺行肾盂内切开术（5297美元）、腹腔镜肾盂成形术（7026美元）及开放肾盂成形术（7119美元）。尽管有不同的住院时间、手术时间、设备成本及成功率数据，但单因素敏感性分析显示，与逆行输尿管镜肾盂内切开术或Acucise肾盂内切开术相比，顺行肾盂内切开术、腹腔镜肾盂成形术及开放肾盂成形术从未具有成本效益，而双因素敏感性分析则支持逆行输尿管镜肾盂内切开术。
输尿管肾盂连接部梗阻治疗的主要成本变量包括手术时间、住院时间、设备成本及成功率。决策树分析表明，在我们机构，逆行输尿管镜或Acucise肾盂内切开术是最具成本效益的治疗方式。然而，成本只是决定最佳治疗方案时需考虑的众多因素之一。
