Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective

Greenwell, T. J., Castle, C., Andrich, D. E., MacDonald, J. T., Nicol, D. L. and Mundy, A. R. (2004) Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. Journal of Urology, 172 1: 275-277. doi:10.1097/01.ju.0000132156.76403.8f


Author Greenwell, T. J.
Castle, C.
Andrich, D. E.
MacDonald, J. T.
Nicol, D. L.
Mundy, A. R.
Title Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective
Journal name Journal of Urology   Check publisher's open access policy
ISSN 0022-5347
Publication date 2004
Sub-type Article (original research)
DOI 10.1097/01.ju.0000132156.76403.8f
Volume 172
Issue 1
Start page 275
End page 277
Total pages 3
Editor J. Y. Gillenwater
Place of publication USA
Publisher Lippincott Williams & Wilkins
Collection year 2004
Language eng
Subject C1
321012 Nephrology and Urology
730109 Surgical methods and procedures
Formatted abstract
Purpose:

We developed an algorithm for the management of urethral stricture based on cost-effectiveness.

Materials and Methods:


United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132).

Results:


The costs were urethrotomy/urethral dilation £2,250.00 ($3,375.00, ratio 1.00), simple 1-stage urethroplasty £5,015.00 ($7,522.50, ratio 2.23), complex 1-stage urethroplasty £5,335.00 ($8,002.50, ratio 2.37) and 2-stage urethroplasty £10,370 ($15,555.00, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was £6,113 ($9,170). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by urethroplasty for recurrence yielded a total cost per patient of £5,866 ($8,799).

Conclusions:


A strategy of initial urethrotomy or urethral dilation followed by urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management.
Keyword Urology & Nephrology
Urethra
Urethral Stricture
Urinary Catheterization
Cost-benefit Analysis
Balloon Dilatation
Internal Urethrotomy
Urethroplasty
Experience
Disease
Repair
Stents
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2005 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 03:33:39 EST