The diagnosis of neoplasia in patients with asymptomatic microscopic hematuria: a decision analysis.

Clinical decision analysis and a computer model were used to evaluate the performance of alternative strategies for the diagnosis of neoplasia in adults with asymptomatic microscopic hematuria. Strategies consisted of sequences of diagnostic tests, including ultrasound, excretory urography, angiography, computerized tomography and cystoscopy. The strategies have a sensitivity of 98 to 100 per cent for bladder cancer and 90 to 94 per cent for renal carcinoma, and a specificity of 99 per cent. The cost per carcinoma diagnosed is $75,000 to $86,000 at 1 per cent prevalence and $5,000 to $5,800 at 15 per cent prevalence. Strategies using cystoscopy or ultrasound as the initial diagnostic test minimized cost and morbidity while maintaining diagnostic accuracy. Excretory urography does not add significantly to diagnostic accuracy but it does add to cost and morbidity.