title: Cost Analysis of Treatments for Ureteropelvic Junction Obstruction.
abstract: Ureteropelvic junction obstruction is a common urologic condition that accounts for approximately $12 million in inpatient spending annually. Few studies have assessed the costs related to treatment. We sought to examine the cost of care for patients treated for ureteropelvic junction obstruction.
  
  
  
  We used the MarketScan®database to identify adults from 18 to 64 years old treated with minimally invasive pyeloplasty, open pyeloplasty, and endopyelotomy for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was total expenditures related to the surgical episode, defined as the period from 30 days prior until 30 days after the index surgery. We fit a multinomial linear regression model to evaluate cost of the surgical episode, adjusting for age, gender, comorbidity, benefit plan type, and region of residence.
  
  
  
  We identified 1251 endopyelotomies, 717 open pyeloplasties, and 1048 minimally invasive pyeloplasties. The adjusted mean costs were $16,379 for endopyelotomy, $22,421 for open pyeloplasty, and $22,843 for minimally invasive pyeloplasty (p < 0.0001, ANCOVA). Both open and minimally invasive pyeloplasties were more costly than endopyelotomy (both p < 0.0001, comparison between groups). However, the cost of open and minimally invasive pyeloplasties was similar (p = 0.57, comparison between groups).
  
  
  
  Among the three treatments, endopyelotomy was the least expensive in the immediate perioperative period. Open and minimally invasive pyeloplasties were similar in cost, but both more expensive than endopyelotomies. The similar cost between the two pyeloplasty approaches provides additional evidence that minimally invasive pyeloplasty should be considered the standard treatment for ureteropelvic junction obstruction.
authors.affiliation: 1 Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California.
authors.forename: Rachana
authors.initials: R
authors.lastname: Seelam
authors.affiliation: 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lai
authors.affiliation: 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Hanley
authors.affiliation: 3 Dell Medical School of the University of Texas , Austin, Texas.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.affiliation: 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.|5 Department of Urology, Division of Oncology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.|6 Department of Urology, Division of Endourology, University of Michigan , Ann Arbor, Michigan.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California.
authors.forename: Claude M
authors.initials: CM
authors.lastname: Setodji
authors.affiliation: 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California.|7 Department of Urology, David Geffen School of Medicine , Santa Monica, California.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000191:economics* / Q000379:methods; D055815:Young Adult
keywords: cost; endopyelotomy; minimally invasive pyeloplasty; open pyeloplasty; ureteropelvic junction obstruction