title: The cost-effectiveness of dextranomer/hyaluronic acid copolymer for the management of vesicoureteral reflux. 2. Reflux correction at the time of diagnosis as a substitute for traditional management.
abstract: OBJECTIVE
  The use of dextranomer/hyaluronic acid copolymer has become increasingly popular as an alternative to ureteral reimplantation in the treatment of vesicoureteral reflux. We compared the cost-effectiveness of performing dextranomer/hyaluronic acid injection at the time of diagnosis of reflux to that of traditional management.
  
  
  METHODS
  A model to estimate the costs of managing vesicoureteral reflux has previously been created. We updated the model to compare the costs of managing vesicoureteral reflux by traditional methods with the costs of managing reflux if dextranomer/hyaluronic acid injection is performed at the time of diagnosis. The success rate required for dextranomer/hyaluronic acid injection at diagnosis to be as cost effective as traditional management was estimated. We used 2 models of dextranomer/hyaluronic acid injection at diagnosis-injection at diagnosis proceeding to traditional management if injection failed (scenario 1), and injection at diagnosis proceeding to ureteral reimplantation if injection failed (scenario 2).
  
  
  RESULTS
  If reflux is stratified by grade in scenario 1, for grades III, IV and V respective success rates of 88.5%, 66.6%, and 55.6% for unilateral reflux and 97.5%, 89.7% and 91.4% for bilateral reflux must be achieved to have equal cost-effectiveness to traditional management, while grades I and II reflux can never achieve equal cost-effectiveness. Stratified by grade for scenario 2, for grades III, IV and V respective success rates of 86.9%, 70.8% and 55.8% for unilateral reflux, and 97.6%, 89.8% and 89.8% for bilateral reflux must be achieved to attain equal cost-effectiveness compared to traditional management. In scenario 2 dextranomer/hyaluronic acid injection at diagnosis for grades I and II unilateral and bilateral reflux can never achieve equal cost-effectiveness compared to traditional management.
  
  
  CONCLUSIONS
  Based on the results of this study, in most clinical situations dextranomer/hyaluronic acid injection at the time of diagnosis is unlikely to be as cost effective as traditional management of vesicoureteral reflux.
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, 5200 Centre Avenue, Pittsburgh, PA 15232, USA. benoitrm@upmc.edu
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Benoit
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Peele
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Cannon
authors.forename: Steven G
authors.initials: SG
authors.lastname: Docimo
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003911:Dextrans / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D007267:Injections; D018803:Models, Economic; D010414:Pennsylvania; D012092:Replantation / Q000191:economics*; D019233:Retreatment / Q000191:economics; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy / Q000191:economics* / Q000601:surgery
chemical_list: D000276:Adjuvants, Immunologic; D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid