From the Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School.
Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA.
Female Pelvic Med Reconstr Surg. 2020 May;26(5):306-313. doi: 10.1097/SPV.0000000000000577.
The aim of this study was to evaluate the cost-effectiveness of retrograde voiding trials in the management of postoperative voiding dysfunction.
We developed a disease simulation model to assess under which conditions routine retrograde voiding trial is the optimal strategy in terms of cost per quality-adjusted life-year and cost per case of chronic voiding dysfunction avoided. We varied the incidence of voiding dysfunction between 2% and 60%. We discounted future costs and utilities at 3% annually. We conducted 1- and 2-way sensitivity analyses on uncertain model parameters.
The lifetime analysis showed that when the incidence of postoperative voiding dysfunction exceeded 12.2%, retrograde voiding trials were cost-effective, assuming a willingness-to-pay (WTP) for health of $100,000/quality-adjusted life-year. When the incidence exceeded 31.1%, retrograde voiding trials became the dominant strategy (less costly and more effective). For a simple hysterectomy with voiding dysfunction incidence of approximately 10%, lifetime cost is $230,069/case of chronic voiding dysfunction avoided; for a midurethral sling with voiding dysfunction incidence of approximately 20%, lifetime cost is $60,449/case avoided. Sensitivity analyses showed that WTP for health, the incidence of presentation to the emergency department (ED) for urinary retention and the incidence of chronic urinary retention following treatment in the ED had the greatest impact on the cost-effectiveness results.
Routine retrograde voiding trials following pelvic surgery can be cost-effective compared with expectant management when the incidence of voiding dysfunction exceeds 12.2%. These results were sensitive to WTP for health, incidence of ED visits for urinary retention, and incidence of chronic urinary retention following ED visits.
本研究旨在评估逆行排尿试验在治疗术后排尿功能障碍中的成本效益。
我们开发了一种疾病模拟模型，以评估在何种情况下，常规逆行排尿试验是避免慢性排尿功能障碍的每例成本和每质量调整生命年成本的最佳策略。我们将排尿功能障碍的发生率在 2%至 60%之间变化。我们按每年 3%对未来成本和效用进行贴现。我们对不确定模型参数进行了 1 维和 2 维敏感性分析。
终生分析表明，当术后排尿功能障碍的发生率超过 12.2%时，逆行排尿试验具有成本效益，假设对健康的支付意愿（WTP）为 100,000 美元/质量调整生命年。当发生率超过 31.1%时，逆行排尿试验成为主导策略（成本更低，效果更好）。对于简单的子宫切除术，排尿功能障碍的发生率约为 10%，终生成本为 230,069 美元/例避免慢性排尿功能障碍；对于尿道中段吊带术，排尿功能障碍的发生率约为 20%，终生成本为 60,449 美元/例避免。敏感性分析表明，健康的 WTP、因尿潴留就诊急诊（ED）的发生率以及 ED 治疗后慢性尿潴留的发生率对成本效益结果影响最大。
与期待治疗相比，在排尿功能障碍发生率超过 12.2%的情况下，盆腔手术后常规进行逆行排尿试验可能具有成本效益。这些结果对健康的 WTP、因尿潴留就诊 ED 的发生率以及 ED 治疗后慢性尿潴留的发生率敏感。
