title: Trends and Patterns of Urodynamic Studies in U.S. Males, 2000-2012.
abstract: OBJECTIVE
  To evaluate trends in urodynamic procedures in the U.S. males from 2000-2012 and determine if a 2010 decline in reimbursement was associated with decreased utilization.
  
  
  METHODS
  We analyzed 2000-2012 administrative healthcare claims from Truven Health's Marketscan Database and evaluated males ≥18 years of age. We identified cystometrograms and any concurrent procedures using procedure billing codes. Covariates included age, year of cystometrogram, region and associated diagnosis codes. We estimated standardized cystometrogram utilization rates per 10,000 person-years (PY). We used age, region, and calendar year adjusted Poisson regression models to estimate the independent effect of calendar year and region.
  
  
  RESULTS
  During 127,558,186 PY of observation, we identified 153,168 cystometrograms for an overall utilization rate of 12.0 per 10,000 PY (95% CI 11.9-12.1). Cystometrogram utilization increased with age, peaking at age 85 with a rate of 77.7 per 10,000 PY (95% CI 74.7-80.7). Adjusted cystometrogram utilization rate ratios show that compared to a referent of 2000-2004, utilization was significantly higher in each year 2005 to 2011 among all patients and in 2012 among patients ≥ 65. Standardized utilization rates peaked in 2008 at 12.4 per 10,000 PY (95% CI 12.2-12.6), remained elevated until 2010, then decreased slightly in 2011 and substantially in 2012 to 8.5 per 10,000 PY (95% CI 8.4-8.7).
  
  
  CONCLUSIONS
  Utilization of urodynamic procedures increased until 2010 and decreased thereafter. Utilization was greatest among men older than 65.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Conover
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Michele
authors.initials: M
authors.lastname: Jonsson Funk
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Kinlaw
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Kristy M
authors.initials: KM
authors.lastname: Borawski
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wu
mesh_terms: D000067575:Administrative Claims, Healthcare / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003950:Diagnostic Techniques, Urological / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014563:Urodynamics