Portal de Periódicos da CAPES

Cost-Effective Treatment for Ureteropelvic Junction Obstruction: A Decision Tree Analysis

2003; Lippincott Williams & Wilkins; Volume: 169; Issue: 1 Linguagem: Inglês

10.1016/s0022-5347(05)64074-8

1527-3792

Matthew T. Gettman, Yair Lotan, Claus G. Roerhborn, Jeffrey A. Cadeddu, Margaret S. Pearle,

Kidney Stones and Urolithiasis Treatments

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2003Cost-Effective Treatment for Ureteropelvic Junction Obstruction: A Decision Tree Analysis MATTHEW T. GETTMAN, YAIR LOTAN, CLAUS G. ROERHBORN, JEFFREY A. CADEDDU, and MARGARET S. PEARLE MATTHEW T. GETTMANMATTHEW T. GETTMAN More articles by this author , YAIR LOTANYAIR LOTAN More articles by this author , CLAUS G. ROERHBORNCLAUS G. ROERHBORN More articles by this author , JEFFREY A. CADEDDUJEFFREY A. CADEDDU More articles by this author , and MARGARET S. PEARLEMARGARET S. PEARLE More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64074-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined the optimal treatment for primary ureteropelvic junction obstruction based on cost using a decision tree model. Materials and Methods: A comprehensive literature search for articles addressing surgical correction of ureteropelvic junction obstruction was performed and data were abstracted on operative time, hospital stay, complications and success rate. The overall cost and individual cost centers at our institution for antegrade endopyelotomy, retrograde ureteroscopic endopyelotomy, Acucise (Applied Medical Resources, Laguna Hills, California) endopyelotomy, laparoscopic pyeloplasty and open pyeloplasty were compared. A decision tree model estimated the cost of treatment and followup for each modality using commercially available software. Sensitivity analyses were performed to evaluate the effect of individual treatment variables on overall cost. Results: Based on cost center review retrograde ureteroscopic endopyelotomy was the least costly procedure ($2,891). In the decision tree model the rank order of overall treatment costs was: retrograde ureteroscopic endopyelotomy ($3,842), Acucise endopyelotomy ($4,427), antegrade endopyelotomy ($5,297), laparoscopic pyeloplasty ($7,026) and open pyeloplasty ($7,119). Despite various hospital stay, operative time, equipment cost and success rate data 1-way sensitivity analysis revealed that antegrade endopyelotomy, laparoscopic pyeloplasty and open pyeloplasty were never cost effective compared with retrograde ureteroscopic endopyelotomy or Acucise endopyelotomy, while 2-way sensitivity analysis favored retrograde ureteroscopic endopyelotomy. Conclusions: Primary cost variables for ureteropelvic junction obstruction treatments include operative time, hospital stay, equipment cost and success rate. Decision tree analysis showed that retrograde ureteroscopic or Acucise endopyelotomy is the most cost-effective treatment modality at our institution. However, cost is only 1 of a number of factors that are considered when deciding on an optimal course of treatment. References 1 : Comparison of open and endourologic approaches to the obstructed ureteropelvic junction. Urology1995; 46: 791. Crossref, Medline, Google Scholar 2 : Retroperitoneal laparoscopic versus open pyeloplasty with a minimal incision: comparison of two surgical approaches. Urology2001; 57: 443. Crossref, Medline, Google Scholar 3 : Laparoscopic versus open pyeloplasty: assessment of objective and subjective outcome. J Urol1999; 162: 692. Link, Google Scholar 4 : Endopyelotomy. Retrograde ureteroscopic approach. Urol Clin North Am1998; 25: 305. Crossref, Medline, Google Scholar 5 : Open surgical exploration after failed endopyelotomy: a 12-year perspective. J Urol1997; 157: 1613. Link, Google Scholar 6 : Long-term results and late recurrence after endoureteropyelotomy: a critical analysis of prognostic factors. J Urol1994; 151: 934. Link, Google Scholar 7 : Endopyelotomy outcome as a function of high versus dependent ureteral insertion. Urology1999; 54: 999. Crossref, Medline, Google Scholar 8 : Endopyelotomy for high-insertion ureteropelvic junction obstruction. J Endourol1998; 12: 127. Crossref, Medline, Google Scholar 9 : Laparoscopic pyeloplasty. Indications, technique, and long-term outcome. Urol Clin North Am1998; 25: 323. Crossref, Medline, Google Scholar 10 : Internet and postal survey of endourologic practice patterns among American urologists. J Urol2000; 163: 1779. Link, Google Scholar 11 : Cost-effectiveness of surgical treatment options in the management of uretero-pelvic junction obstruction. J Urol1996; 155: 500A. abstract 758. Google Scholar 12 : Adult endopyelotomy: impact of etiology and antegrade versus retrograde approach on outcome. J Urol1998; 160: 685. Link, Google Scholar 13 : Acucise endopyelotomy: assessment of long-term durability. J Urol1996; 156: 1094. Link, Google Scholar 14 : A multicenter clinical trial investigating the use of a fluoroscopically controlled cutting balloon catheter for the management of ureteral and ureteropelvic junction obstruction. J Urol1997; 157: 1625. Link, Google Scholar 15 : Retrograde treatment of ureteropelvic junction obstruction using the ureteral cutting balloon catheter. J Urol1997; 157: 454. Link, Google Scholar 16 : Pelvi-ureteric junction obstruction treated with acucise retrograde endopyelotomy. Br J Urol1998; 82: 8. Crossref, Medline, Google Scholar 17 : Complications of acucise endopyelotomy. J Endourol1998; 12: 433. Crossref, Medline, Google Scholar 18 : Ureteroscopic treatment of ureteropelvic junction obstruction. J Urol1998; 160: 1643. Link, Google Scholar 19 : Ureteroscopic endopyelotomy at a single setting. J Urol1998; 159: 727. Link, Google Scholar 20 : Ureteroscopic endopyelotomy in the treatment of patients with ureteropelvic junction obstruction. Urology2000; 55: 198. Crossref, Medline, Google Scholar 21 : Percutaneous antegrade endopyelotomy: review of 50 consecutive cases. J Urol1995; 153: 701. Link, Google Scholar 22 : Extraperitoneal laparoscopic repair of ureteropelvic junction obstruction: initial experience in 15 cases. Urology2000; 56: 45. Crossref, Medline, Google Scholar 23 : Laparoscopic pyeloplasty. Urol Clin North Am2000; 27: 695. Crossref, Medline, Google Scholar From the Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Kartal I, Çimen S, Karakoyunlu N, Sandıkçı F, Eraslan A and Yalçınkaya F (2020) Factors affecting the effectiveness and success of retrograde holmium laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adultsUrologia Journal, 10.1177/0391560320904259, VOL. 88, NO. 1, (34-40), Online publication date: 1-Feb-2021. Uhlig A, Uhlig J, Trojan L, Hinterthaner M, von Hammerstein-Equord A and Strauss A (2019) Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysisBMC Urology, 10.1186/s12894-019-0544-7, VOL. 19, NO. 1, Online publication date: 1-Dec-2019. Elmussareh M, Traxer O, Somani B and Biyani C (2017) Laser Endopyelotomy in the Management of Pelviureteric Junction Obstruction in Adults: A Systematic Review of the LiteratureUrology, 10.1016/j.urology.2017.04.018, VOL. 107, (11-22), Online publication date: 1-Sep-2017. Geavlete P, Mirciulescu V, Niţă G and Geavlete B (2016) Percutaneous Approach in Pyeloureteral Junction Stenosis Percutaneous Surgery of the Upper Urinary Tract, 10.1016/B978-0-12-802404-1.00005-0, (113-131), . Ramirez D and Lotan Y (2015) Cost-Effectiveness in Minimally Invasive Urologic Surgery Minimally Invasive Urology, 10.1007/978-1-4939-1317-6_19, (239-250), . Sutherland T, Pearle M and Lotan Y (2013) How Much is a Kidney Worth? Cost-Effectiveness of Routine Imaging After Ureteroscopy to Prevent Silent ObstructionJournal of Urology, VOL. 189, NO. 6, (2136-2141), Online publication date: 1-Jun-2013. Faddegon S and Pearle M (2013) Ureteroscopy in 2012: The Scope of the Scope Ureteroscopy, 10.1007/978-1-62703-206-3_2, (13-25), . Bader P (2012) Nierenbeckenplastik – pro laparoskopischPyeloplasty: pro laparoscopicDer Urologe, 10.1007/s00120-012-2860-3, VOL. 51, NO. 5, (633-639), Online publication date: 1-May-2012. Nakada S and Hsu T (2012) Management of Upper Urinary Tract Obstruction Campbell-Walsh Urology, 10.1016/B978-1-4160-6911-9.00041-4, (1122-1168.e7), . Cerrito P and Cerrito J (2010) Decision Trees and Their Development Clinical Data Mining for Physician Decision Making and Investigating Health Outcomes, 10.4018/978-1-61520-905-7.ch013, (287-304) Stilling N, Jung H, Nørby B, Osther S and Osther P (2009) Retrograde ureteroscopic holmium laser endopyelotomy in a selected population of patients with ureteropelvic junction obstructionScandinavian Journal of Urology and Nephrology, 10.1080/00365590802473164, VOL. 43, NO. 1, (68-72), Online publication date: 1-Jan-2009. Hsieh M, Meng M and Baskin L (2008) Outcomes and Cost Analysis of Pyeloplasty for Antenatally Diagnosed Ureteropelvic Junction Obstruction Using Markov ModelsUrology, 10.1016/j.urology.2007.12.093, VOL. 72, NO. 4, (794-799), Online publication date: 1-Oct-2008. Clayman R, Marshall F, Berger R, Niederberger C and Canning D (2007) 2007 Best of the Rest in Urological SurveyJournal of Urology, VOL. 178, NO. 6, (2239-2245), Online publication date: 1-Dec-2007. Herrmann T, Bach T, Imkamp F, Tezval H, Klot C, Jonas U, Gross A and Burchardt M (2007) FlexGuardTM: a new laser insertion sheath: functional aspects in ureterorenoscopy (URS)World Journal of Urology, 10.1007/s00345-007-0176-5, VOL. 25, NO. 3, (269-273), Online publication date: 1-Jun-2007. Lam J, Breda A and Schulam P (2018) Ureteropelvic Junction ObstructionJournal of Urology, VOL. 177, NO. 5, (1652-1658), Online publication date: 1-May-2007.Clayman R (2018) Urolithiasis, Endourology and LaparoscopyJournal of Urology, VOL. 177, NO. 3, (988-991), Online publication date: 1-Mar-2007. Stein R, Gill I and Desai M (2008) Comparison of surgical approaches to ureteropelvic junction obstruction: Endopyeloplasty versus endopyelotomy versus laparoscopic pyeloplastyCurrent Urology Reports, 10.1007/s11934-007-0064-y, VOL. 8, NO. 2, (140-149), Online publication date: 1-Mar-2007. Baard J, de Reijke T and de la Rosette J (2008) The use of the acucise technique for ureteropelvic junction obstruction: A trade-off between efficacy and invasiveness?Current Urology Reports, 10.1007/s11934-007-0063-z, VOL. 8, NO. 2, (134-139), Online publication date: 1-Mar-2007. Giorgi L and Moran M (2006) LAPAROSCOPIC SUTURING Textbook of Laparoscopic Urology, 10.3109/9781420021202-16, (159-182), Online publication date: 3-Oct-2006. GAO Z, SHI L, YANG M, WANG L, YANG D, SUN D, LIU Q, MEN C, WU J and ZHANG P (2006) Combination of laparoscopic and open procedure in dismembered pyeloplasty: report of 51 casesChinese Medical Journal, 10.1097/00029330-200605020-00008, VOL. 119, NO. 10, (840-844), Online publication date: 1-May-2006. Minervini A, Davenport K, Keeley F and Timoney A (2006) Antegrade versus Retrograde Endopyelotomy for Pelvi-Ureteric Junction (PUJ) ObstructionEuropean Urology, 10.1016/j.eururo.2005.11.025, VOL. 49, NO. 3, (536-543), Online publication date: 1-Mar-2006. Springhart W and Preminger G Retrograde Endopyelotomy Advanced Endourology, 10.1007/978-1-59259-954-7_11, (183-195) Tan B, El-Hakim A, Lee B and Smith A Antegrade Endopyelotomy Advanced Endourology, 10.1007/978-1-59259-954-7_10, (159-182) Inagaki T, Rha K, Ong A, Kavoussi L and Jarrett T (2005) Laparoscopic pyeloplasty: current statusBJU International, 10.1111/j.1464-410X.2005.05208.x, VOL. 95, NO. s2, (102-105), Online publication date: 1-Mar-2005. (2005) Current World LiteratureCurrent Opinion in Urology, 10.1097/01.mou.0000160630.81978.ac, VOL. 15, NO. 2, (139-147), Online publication date: 1-Mar-2005. Collins J, Keeley F and Timoney A (2004) Cost analysis of flexible ureterorenoscopyBJU International, 10.1111/j.1464-410X.2003.04774.x, VOL. 93, NO. 7, (1023-1026) Tan B and Smith A (2004) Ureteropelvic junction obstruction repair: when, how, what?Current Opinion in Urology, 10.1097/00042307-200403000-00002, VOL. 14, NO. 2, (55-59), Online publication date: 1-Mar-2004. Andreoni C, Srougi M, Ortiz V and Clayman R (2004) Acucise™ endopyelotomy in a porcine model: procedure standardization and analysis of safety and immediate efficacyInternational braz j urol, 10.1590/S1677-55382004000100013, VOL. 30, NO. 1, (59-65), Online publication date: 1-Feb-2004. HEMAL A, GOEL R and GOEL A (2003) Cost-effective laparoscopic pyeloplasty: Single center experienceInternational Journal of Urology, 10.1046/j.1442-2042.2003.00706.x, VOL. 10, NO. 11, (563-568), Online publication date: 1-Nov-2003. Volume 169 Issue 1 January 2003 Page: 228-232 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordskidneyureterureteral obstructioncost-benefit analysisdecision treesMetrics Author Information MATTHEW T. GETTMAN More articles by this author YAIR LOTAN More articles by this author CLAUS G. ROERHBORN More articles by this author JEFFREY A. CADEDDU More articles by this author MARGARET S. PEARLE More articles by this author Expand All Advertisement PDF downloadLoading ...