Resource utilization and costs associated with the diagnostic evaluation of nonrefluxing primary hydronephrosis in infants.
OBJECTIVE
Long-term evaluation of postnatal nonrefluxing primary hydronephrosis presents a dilemma for urologists since most cases resolve without surgery. We report longitudinal resource utilization and costs associated with diagnostic evaluation of infants with isolated primary nonrefluxing hydronephrosis to determine the costs associated with diagnosing a surgical case, and we assess the implications using a cost-consequences analysis.


METHODS
A retrospective chart review was used to capture resource utilization for all patients younger than 6 months with hydronephrosis evaluated at our institution during a 5-year period. Infants with confounding urological diagnoses were excluded. Payer and societal perspectives were used. Costs were estimated from resource utilization, including radiographic imaging and clinical encounter types. Data were collected from first clinic visit until surgery or resolution or 3 years, whichever was shortest.


RESULTS
Of 165 included patients surgical rates for hydronephrosis were 0% for grade I, 5% for grade II, 21% for grade III and 74% for grade IV. Median respective costs of identifying a single surgical case per increasing hydronephrosis grade 0 to IV were infinite, $37,600, $11,741 and $2,124 (p <0.001), respectively.


CONCLUSIONS
Diagnostic evaluation of higher grades of hydronephrosis is significantly more productive in terms of identifying patients requiring surgery vs evaluation of patients with lower grade disease. In patients with grades I and II hydronephrosis a more abbreviated diagnostic strategy than the current standard of care may be warranted. For the population in this analysis we project that a less intensive approach could save about 24% of costs.
Department of Urology, University of Washington Medical Center, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington.
Ardavan
A
Akhavan
Department of Urology, University of Washington Medical Center, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington.
Margarett
M
Shnorhavorian
Department of Pharmacy, University of Washington, Seattle, Washington.
Louis P
LP
Garrison
Department of Urology, University of Washington Medical Center, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington.
Paul A
PA
Merguerian
D003365:Costs and Cost Analysis; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis* / Q000191:economics*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies
costs and cost analysis; diagnosis; health care economics and organizations; hydronephrosis; ureteral obstruction