Selective cystoscopy during hysterectomy reduces costs
Selective intraoperative cystoscopy during benign hysterectomy appears to reduce costs compared with routine cystoscopy or no cystoscopy, according to findings of a study published in the American Journal of Obstetrics and Gynecology.
Decision analysis models populated with data from published literature were used to compare selective, routine or no intraoperative cystoscopy during abdominal hysterectomy, vaginal hysterectomy or laparoscopic/robotic hysterectomy, from a US third party payer perspective. Costs of complications including peritonitis, urinoma, and vesicovaginal or ureterovaginal fistula were included.
The estimated incidence of bladder injury was 2.91% with vaginal hysterectomy, 1.61% with abdominal hysterectomy, and 0.93% with laparoscopic/robotic hysterectomy, while the incidence of ureteral injury was 1.61% with abdominal hysterectomy and 0.46% with laparoscopic/robotic or vaginal hysterectomy.
Estimated hysterectomy costs ranged from $884.891 to $1121.91 with no cystoscopy; incremental costs were $13.20−$26.13 with selective cystoscopy versus no cystoscopy, and $51.39−$57.86 with routine cystoscopy versus selective cystoscopy.
Selective cystoscopy was cost saving compared with no cystoscopy when the risk of bladder injury was over 4.48%−11.44% (depending on the method of hysterectomy) or the risk of ureteral injury was over 3.96%−8.95%. Routine cystoscopy would only become cost saving if the risk of bladder injury was over 20.59%−47.24% or the risk of ureteral injury was over 27.22%−37.72%.
"Our model suggests that selective cystoscopy is the best option in the case of benign hysterectomy as it minimally increases cost per hysterectomy but becomes cost saving with modest increases in risk of injury," said the authors.
2017 US dollars
- Cadish LA, et al. Cystoscopy at the time of benign hysterectomy: A decision analysis. American Journal of Obstetrics and Gynecology : 24 Jan 2019. Available from: URL: http://doi.org/10.1016/j.ajog.2019.01.217