Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence.
OBJECTIVE
This study was undertaken to compare cost-effectiveness between 2 preoperative testing strategies for women with pelvic organ prolapse and stress urinary incontinence symptoms.


METHODS
We developed decision-analytic models that evaluated the cost-effectiveness of basic office evaluation before surgery in women with prolapse and stress urinary incontinence symptoms and contrasted it with that of urodynamic testing. Costs were obtained from the Federal Register; effectiveness of treatment for urinary incontinence was based on the published literature.


RESULTS
The strategies of basic office evaluation and urodynamic testing had the same cure rate of urinary incontinence (96%) after initial and secondary treatment. Under baseline assumptions incremental cost-effectiveness (cost for single extra cure of urinary incontinence) of urodynamic testing was $328,601. According to sensitivity analyses, basic office evaluation was more cost-effective than urodynamic testing when the prevalence of pure detrusor instability was <8% or when the cost of urodynamic testing was >$103.


CONCLUSIONS
Urodynamic testing before surgery in women with prolapse and stress urinary incontinence symptoms is not cost-effective relative to basic office evaluation.
Weber
A M
AM
Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, OH 44195, USA.
Walters
M D
MD
D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D009819:Office Visits; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D014563:Urodynamics; D014596:Uterine Prolapse / Q000150:complications*