Postprostatectomy urinary incontinence: a comparison of the cost of conservative versus surgical management.
OBJECTIVE
Post-radical prostatectomy stress incontinence occurs in up to 20% of patients. Postprostatectomy incontinence is initially treated with undergarments, pads, or drip collectors. Patients with persistent leakage are often treated with a transurethral bulking agent (Contigen) or placement of an artificial genitourinary sphincter (AGUS). We have compared the direct costs of each treatment at our institution over 10 years.


METHODS
The Mayo Clinic estimating office provided the Medicare and non-Medicare charges for patients receiving both collagen injection (outpatient) and AGUS placement (2-day hospitalization) during August 1995. The Mayo Store provided the current price of all undergarments, pads, and drip collectors carried. Two local grocery stores provided the cost of Depends undergarments.


RESULTS
The following items were the least expensive carried at the Mayo Clinic Store: Entrust undergarments, Active Style pads, and Conveen drip collectors at $0.99, $0.52, $1.05 each, respectively. The average cost of Depends undergarments was $0.52 each. The cost of wearing 5 of the least expensive undergarments or pads per day for 10 years is $9497. The average estimated Medicare and non-Medicare cost for outpatient (general anesthesia) collagen injection is $4300 and $5625, respectively. The average Medicare and non-Medicare cost for AGUS placement is $15,400 and $20,300, respectively. Factoring in our current 22.4% reoperation rate, the average per patient Medicare and non-Medicare cost for AGUS placement is $18,850 and $24,847, respectively.


CONCLUSIONS
The cost of the AGUS placement compares favorably with the cost of transurethral collagen injection (under general anesthesia) in patients requiring several (more than three) collagen injection treatments or requiring the continued use of undergarments after collagen injection. Whereas the cost of transurethral collagen injection, when effective, compares favorably with conservative treatment, AGUS placement is significantly more expensive than conservative management for almost all patients except the exceedingly rare patient wearing more than 9 undergarments or pads per day. When the psychosocial benefit of urinary continence is considered, however, transurethral injection of collagen or AGUS placement often becomes the preferred treatment.
Brown
J A
JA
Division of Urology, David Grant Medical Center, Travis Air Force Base, California, USA.
Elliott
D S
DS
Barrett
D M
DM
D000556:Ambulatory Surgical Procedures / Q000191:economics; D000768:Anesthesia, General / Q000191:economics; D001294:Attitude to Health; D003094:Collagen / Q000627:therapeutic use; D004180:Direct Service Costs; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016496:Incontinence Pads / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics; D017060:Patient Satisfaction; D011468:Prostatectomy / Q000009:adverse effects*; D019736:Prostheses and Implants / Q000191:economics; D019919:Prosthesis Implantation / Q000191:economics; D011788:Quality of Life; D012086:Reoperation / Q000191:economics; D014481:United States; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000209:etiology / Q000523:psychology / Q000601:surgery / Q000628:therapy; D014572:Urology / Q000191:economics / Q000295:instrumentation
D003094:Collagen