World Journal of Urology

, Volume 27, Issue 3, pp 379–383

The value of newborn urinary proteome analysis in the evaluation and management of ureteropelvic junction obstruction: a cost-effectiveness study

Original Article

Abstract

Purpose

The cornerstone of management in newborns with ureteropelvic junction obstruction (UPJO) is serial imaging over time. Surgery is undertaken for disease progression. A marker of disease progression would select out those likely to progress for early surgery and diminish the intensity of imaging and follow-up in the remainder. Recently, urinary proteome analysis in the newborn has been reported to fulfill this aim. The objective of this study is to quantitatively evaluate the effect of this matrix of protein biomarkers on the overall cost-effectiveness (C-E) of UPJO evaluation and management.

Methods

A Markov process decision tree model (Tree Age Pro software, Boston, MA) is created to compare the current strategy (watchful waiting) to one incorporating a urine proteome analysis at birth as a marker of disease progression. The analysis includes the costs of surgery, imaging and office visits based on hospital charge data. We analyze a total of 53 variables.

Results

The incorporation of this marker of progression results on the average, in an incremental C-E gain of $8,000 per quality adjusted life year (QALY) per patient compared to the current strategy of watchful waiting. The results are not sensitive to variation of any of the probabilities including costs and quality of life parameters used for the base-case analysis.

Conclusions

The incorporation of urinary proteome analysis in the initial evaluation of UPJO significantly reduces costs and increases the QALYs in this patient population. The test increases the odds of detecting UPJO progression from 1:3 to 1:1, while improving the overall C-E. These findings justify continued research in this area which in addition may have important applications in evaluating treatment outcomes.

Keywords

Ureteropelvic junction disease or obstruction Hydronephrosis Cost-effectiveness analysis Quality adjusted life years 

References

  1. 1.
    Dhillon HK (1998) Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. BJU 81(2):39–44PubMedCrossRefGoogle Scholar
  2. 2.
    Ulman I, Jayanthi VR, Koff SA (2000) The long-term follow-up of newborns with severe unilateral hydronephrosis initially managed nonoperatively. J Urol 164:1101–1105PubMedCrossRefGoogle Scholar
  3. 3.
    Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23:478–480PubMedCrossRefGoogle Scholar
  4. 4.
    Palmer LS, Maizels M, Cartwright PC et al (1998) Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol 159:222–228PubMedCrossRefGoogle Scholar
  5. 5.
    Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon J, Barratt TM (1990) The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 144:584PubMedGoogle Scholar
  6. 6.
    Hsieh MH, Meng MV (2007) Decision analysis and Markov modeling in urology. J Urol 178:1867–1874PubMedCrossRefGoogle Scholar
  7. 7.
    Mesrobian H-G (2005) Best strategy for evaluation and management of hydronephrosis in newborns and infants: a cost-effectiveness analysis based approach. Medical College of Wisconsin Library. Dissertation submitted to the faculty of the graduate school of Biomedical SciencesGoogle Scholar
  8. 8.
    Birth Data from the National Center for Health Statistics (2003) vol 52 (10)Google Scholar
  9. 9.
    Fefer S, Ellsworth P (2006) Prenatal hydronephrosis. Pediatr Clin North Am 53:429–447PubMedCrossRefGoogle Scholar
  10. 10.
    Decramer S, Bascands J-L, Schanstra JP (2007) Non-invasive markers of ureteropelvic junction obstruction. World J Urol 25:457–465PubMedCrossRefGoogle Scholar
  11. 11.
    Tengs TO, Wallace A (2000) One thousand health-related quality of life estimates. Medical Care (38):583–637Google Scholar
  12. 12.
    Drummond MF (1996) Guidelines for authors and peer reviewers of economic submission to the BMJ. BMJ 313:275–283PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of UrologyChildren’s Hospital and Medical College of WisconsinMilwaukeeUSA

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