Assessing the Costs of Extraurinary Findings of Computed Tomography Urogram in the Evaluation of Asymptomatic Microscopic Hematuria.
OBJECTIVE
To assess the costs associated with incidental extraurinary findings on computed tomography urogram (CTU) in patients with asymptomatic microscopic hematuria.


METHODS
A retrospective review was performed to identify all CTUs performed for asymptomatic microscopic hematuria at our institution from 2012 to 2014. All genitourinary (GU) and incidental extraurinary findings were documented. Further clinical follow-up to May 2015 was reviewed to determine if any referrals, tests, imaging, and/or procedures were ordered based on the initial CTU. Cost estimates were determined using the Medicare physician reimbursement rate.


RESULTS
Two hundred two patients were evaluated with CTU for asymptomatic microscopic hematuria. GU malignancy was documented in 2 patients (0.99%), both renal masses suspicious for renal cell carcinoma. Sixty patients were found to have kidney stones, of which 26 had stones ≥5 mm. Incidental extraurinary findings were found in 150 (74.3%) patients, requiring further imaging costs of $17,242 or $85.35 per patient screened. Twelve patients required a total of 20 procedures for a cost of $54,655. The total cost related to extraurinary findings was $140,290 or $694.50 per initial patient screened.


CONCLUSIONS
The incidental extraurinary findings detected on CTU can lead to expensive and invasive testing and treatment. Whereas costs associated with further workup were high, the overall outcomes in both GU and non-GU cancer diagnosis were low. Future analysis should focus on limiting the cost and invasiveness of our evaluation for this condition.
Department of Urology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: wslai@uabmc.edu.
Win Shun
WS
Lai
School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
James
J
Ellenburg
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
Mark E
ME
Lockhart
Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
Peter N
PN
Kolettis
D058070:Asymptomatic Diseases; D005260:Female; D017048:Health Care Costs; D006417:Hematuria / Q000000981:diagnostic imaging* / Q000191:economics* / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014567:Urography / Q000191:economics* / Q000379:methods*