Economic analysis of infant vs postpubertal orchiopexy to prevent testicular cancer.
OBJECTIVE
To use decision analysis to determine the economic benefits of early vs late orchiopexy, specifically with respect to testicular cancer development and management. Studies have suggested that prepubertal orchiopexy might confer additional protection from the development of testicular cancer compared with postpubertal orchiopexy. Infant surgery is often performed by pediatric subspecialists and hence might be more costly. Although rare, testicular cancer can require significant medical expenditures.


METHODS
We examined the resource index (RI) (physician charges and hospital costs) from the medical establishment's perspective. Economic modeling was performed to determine whether early or late orchiopexy minimized the RI. The stage- and histologic-specific costs of subsequent testicular cancer were incorporated into our models. The variables were tested over realistic ranges in the sensitivity analysis to determine the threshold values.


RESULTS
In the base case analysis, the RI for infant and postpubertal orchiopexy was $7500 and $10,928 per patient, respectively. The sensitivity analysis demonstrated that the costs for operating room time, physicians' fees, operative times, and baseline cancer risk were important parameters. However, only the surgeons' fees demonstrated threshold values. The RI for treating cancer and the cancer risk reduction after early orchiopexy did not significantly affect our models.


CONCLUSIONS
Our models of orchiopexy for prevention of testicular cancer showed that infant orchiopexy is less costly than later surgery, provided that the surgeons' fees are not excessive. It appears that early surgery might significantly reduce the treatment costs of testicular cancer for cryptorchid boys and supports the current standard of care in the United States.
Hsieh
Michael H
MH
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA. mhhsieh@stanfordalumni.org
Roth
David R
DR
Meng
Maxwell V
MV
D000293:Adolescent; D000367:Age Factors; D003456:Cryptorchidism / Q000150:complications / Q000601:surgery*; D003661:Decision Support Techniques; D003663:Decision Trees; D006801:Humans; D007223:Infant; D008297:Male; D013736:Testicular Neoplasms / Q000209:etiology / Q000517:prevention & control*; D013521:Urologic Surgical Procedures, Male / Q000191:economics*