title: Endoscopic subureteral injection is not less expensive than outpatient open reimplantation for unilateral vesicoureteral reflux.
abstract: OBJECTIVE
  Extravesical ureteral reimplantation and subureteral Deflux injection are used to correct vesicoureteral reflux with success rates of 94% to 99% and up to 89%, respectively. It was reported that unilateral extravesical reimplantation may be performed safely in an outpatient setting. Given that, we analyzed total system reimbursement to compare planned outpatient unilateral extravesical reimplantation to subureteral Deflux injection in patients with unilateral vesicoureteral reflux.
  
  
  METHODS
  Data were collected on consecutive patients undergoing outpatient procedures for unilateral vesicoureteral reflux. Assessment of total system reimbursement was made using a payer mix adjusted calculation of surgery plus anesthesia plus hospital reimbursement. This was compared per procedure and in terms of total system reimbursement for each approach to obtain a similar resolution rate.
  
  
  RESULTS
  A total of 209 consecutive patients were identified, of whom 26 underwent subureteral Deflux injection and 183 underwent unilateral extravesical reimplantation. Mean operative time was 93 minutes for reimplantation and 45 minutes for injection. The mean volume of dextranomer-hyaluronic acid was 1.2 ml. Total initial system reimbursement per patient was $3,813 for reimplantation and $4,259 for injection. A 3% hospital admission rate for reimplantation increased the total to $3,945. Higher reimbursement for injection depended largely on the material expense for dextranomer-hyaluronic acid.
  
  
  CONCLUSIONS
  In terms of total system reimbursement it is less expensive in our system to treat unilateral vesicoureteral reflux with unilateral extravesical reimplantation than with subureteral Deflux injection using dextranomer-hyaluronic acid. The ability to perform unilateral reimplantation as an outpatient procedure has shifted this relationship.
authors: University of Utah, Salt Lake City, Utah, USA. kara.saperston@hsc.utah.edu
authors: Kara
authors: K
authors: Saperston
authors: James
authors: J
authors: Smith
authors: Scott
authors: S
authors: Putman
authors: Richard
authors: R
authors: Matern
authors: Laura
authors: L
authors: Foot
authors: Chad
authors: C
authors: Wallis
authors: Catherine
authors: C
authors: deVries
authors: Brent
authors: B
authors: Snow
authors: Patrick
authors: P
authors: Cartwright
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000758:Anesthesia / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003911:Dextrans / Q000008:administration & dosage / Q000191:economics*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000191:economics*; D008297:Male; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000191:economics*; D012092:Replantation / Q000191:economics*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014589:Utah; D014718:Vesico-Ureteral Reflux / Q000191:economics* / Q000601:surgery
chemical_list: D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid