title: The cost of preoperative urodynamics: A secondary analysis of the ValUE trial.
abstract: OBJECTIVE
  Urodynamic studies (UDS) are generally recommended prior to surgical treatment for stress urinary incontinence (SUI), despite insufficient evidence that it impacts treatment plans or outcomes in patients with uncomplicated SUI. This analysis aimed to calculate the cost incurred when UDS was performed as a supplement to a basic office evaluation and to extrapolate the potential savings of not doing UDS in this patient population on a national basis.
  
  
  METHODS
  This is a secondary analysis from the Value of Urodynamic Evaluation (ValUE) trial, a multicenter non-inferiority randomized trial to determine whether a basic office evaluation (OE) is non-inferior in terms of SUI surgery outcomes to office evaluation with addition of urodynamic studies (UDS). All participants underwent an OE; those patients who randomized to supplementary UDS underwent non-instrumented uroflowmetry, filling cystometry, and a pressure flow study. Costs associated with UDS were calculated using 2014 U.S. Medicare allowable fees. Models using various patient populations and payor mixes were created to obtain a range of potential costs of performing UDS in patients undergoing SUI surgery annually in the United States.
  
  
  RESULTS
  Six hundred thirty women were randomized to OE or OE plus UDS. There was no difference in surgical outcomes between the two groups. The per patient cost of UDS varied from site to site, and included complex cystometrogram $314-$343 (CPT codes 51728-51729) plus complex uroflowmetry $16 (CPT code 51741). Extrapolating these costs for US women similar to our study population, 13-33 million US dollars could be saved annually by not performing preoperative urodynamics.
  
  
  CONCLUSIONS
  For women with uncomplicated SUI and a confirmatory preoperative basic office evaluation, tens of millions of dollars US could be saved annually by not performing urodynamic testing. In the management of such women, eliminating this preoperative test has a major economic benefit.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Peggy A
authors.initials: PA
authors.lastname: Norton
authors.affiliation: University of California, San Diego, California.|Kaiser Permanente Southern California, San Diego, California.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Nager
authors.affiliation: Stritch School of Medicine Loyola University, Chicago, Illinois.
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Lemack
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Larry T
authors.initials: LT
authors.lastname: Sirls
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Robert
authors.initials: R
authors.lastname: Holley
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: Toby C
authors.initials: TC
authors.lastname: Chai
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kraus
authors.affiliation: University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania.
authors.forename: Halina
authors.initials: H
authors.lastname: Zyczynski
authors.affiliation: Stritch School of Medicine Loyola University, Chicago, Illinois.
authors.forename: Bridget
authors.initials: B
authors.lastname: Smith
authors.affiliation: New England Research Institutes, Watertown, Massachusetts.
authors.forename: Anne
authors.identifier: http://orcid.org/0000-0002-2960-9931
authors.initials: A
authors.lastname: Stoddard
mesh_terms: D003362:Cost-Benefit Analysis; D003950:Diagnostic Techniques, Urological / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D011300:Preoperative Care / Q000191:economics*; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics / Q000502:physiology*; D013520:Urologic Surgical Procedures / Q000191:economics*
keywords: cost of urodynamics; urodynamics