Benoit Ronald M, Peele Pamela B, Docimo Steven G
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
J Urol. 2006 Oct;176(4 Pt 1):1588-92; discussion 1592. doi: 10.1016/j.juro.2006.06.031.
We examined the cost-effectiveness of dextranomer/hyaluronic acid copolymer injection in patients who would otherwise undergo ureteral reimplantation.
A model for managing vesicoureteral reflux has previously been created. We now update the model to compare the costs of treating vesicoureteral reflux using standard methods (ie ureteral reimplantation after failed medical therapy) with the costs of dextranomer/hyaluronic acid injection.
In the first scenario created dextranomer/hyaluronic acid injection is substituted for ureteral reimplantation when surgical intervention would be performed for treatment of breakthrough infection or failure of the reflux to resolve. For dextranomer/hyaluronic acid injection to have equal cost-effectiveness compared to ureteral reimplantation in this scenario success rates for dextranomer/hyaluronic acid injection would need to be 57.8% per ureter for patients with unilateral reflux and 75.3% per ureter for patients with bilateral reflux. However, if increasing grades of reflux require increasing volumes of dextranomer/hyaluronic acid, success rates would need to be 72.5% for patients with unilateral reflux and 93.8% for patients with bilateral reflux. In the second scenario created dextranomer/hyaluronic acid injection is repeated if it fails to resolve the reflux after the first injection. Success rates to obtain equal cost-effectiveness for the repeat dextranomer/hyaluronic acid injection would need to be 0%, 11.4% and 60.3% in patients with unilateral reflux if the respective success rates of the initial injection were 85%, 70% and 55%. Success rates for the second dextranomer/hyaluronic acid injection would need to be 0%, 29.1% and 76.7% per ureter in patients with bilateral reflux if the respective success rates of the initial injection were 85%, 70% and 55%. If increasing volumes of dextranomer/hyaluronic acid were required for increasing grades of reflux, a second dextranomer/hyaluronic acid injection would not be a viable option.
Based on our results, dextranomer/hyaluronic acid injection may be more cost-effective than ureteral reimplantation for children who meet standard criteria for surgical therapy, especially for lower grades of reflux. If increasing grades of reflux require an increased volume of dextranomer/hyaluronic acid, then injection would likely be cost-effective only for grades I and II unilateral and bilateral reflux, and perhaps unilateral grade III reflux.
我们研究了葡聚糖凝胶/透明质酸共聚物注射对于原本需接受输尿管再植术患者的成本效益。
先前已建立了一个用于管理膀胱输尿管反流的模型。我们现在更新该模型，以比较使用标准方法（即药物治疗失败后进行输尿管再植术）治疗膀胱输尿管反流的成本与葡聚糖凝胶/透明质酸注射的成本。
在创建的第一种情景中，当因突破性感染或反流未缓解而需进行手术干预时，用葡聚糖凝胶/透明质酸注射替代输尿管再植术。在此情景下，要使葡聚糖凝胶/透明质酸注射与输尿管再植术具有同等成本效益，对于单侧反流患者，葡聚糖凝胶/透明质酸注射每个输尿管的成功率需达到57.8%；对于双侧反流患者，每个输尿管的成功率需达到75.3%。然而，如果反流程度增加需要更多体积的葡聚糖凝胶/透明质酸，那么对于单侧反流患者，成功率需达到72.5%；对于双侧反流患者，成功率需达到93.8%。在创建的第二种情景中，如果首次注射后葡聚糖凝胶/透明质酸注射未能解决反流问题，则重复注射。如果初始注射的成功率分别为85%、70%和55%，那么对于单侧反流患者，重复注射葡聚糖凝胶/透明质酸以获得同等成本效益所需的成功率分别为0%、11.4%和60.3%。对于双侧反流患者，如果初始注射的成功率分别为85%、70%和55%，那么第二次注射葡聚糖凝胶/透明质酸每个输尿管的成功率需分别为0%、29.1%和76.7%。如果反流程度增加需要更多体积的葡聚糖凝胶/透明质酸，那么第二次注射葡聚糖凝胶/透明质酸将不是一个可行的选择。
基于我们的研究结果，对于符合手术治疗标准的儿童，尤其是对于较低级别的反流，葡聚糖凝胶/透明质酸注射可能比输尿管再植术更具成本效益。如果反流程度增加需要更多体积的葡聚糖凝胶/透明质酸，那么注射可能仅对于I级和II级单侧及双侧反流以及可能的单侧III级反流具有成本效益。
