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OPERATING ROOM COST ANALYSIS: A SURVEY OF COST AWARENESS AMONG UROLOGIC SURGERY STAFF
56
THE JOURNAL OF UROLOGY®
METHODS: SNS billing codes for procedures, durable medical equipment (DME), and hospital admission were derived from commonly billed codes issued to providers by the SNS manufacturer. IIntra-detrusor injection of BoNTA billing codes were based on recommended BoNTAVSHFL¿FFRGHVIRU2$%IURPDODUJHKHDOWKSODQ3URFHGXUHFRVWVZHUH based on the Center for Medicare and Medicaid Services (CMS) National Physician Fee Schedule Relative Value File. DME costs were based on the CMS DME Point-of-Service Fee Schedule. BoNTA drug cost was calculated using CMS Average Selling Price assuming 300 units of BoNTA for NDO and 200 units for IDO patients. SNS hospital admission costs were based on CMS DRG price schedules. Although uncertainty H[LVWVLQWKHGXUDWLRQRIHI¿FDF\ZHDVVXPHGDQDYHUDJHRIDPRQWK duration for SNS and 6-month duration for BoNTA in order to estimate ¿UVW\HDUFRVWV$OOFRVWVZHUHUHSRUWHGLQ86GROODUV RESULTS: The average SNS one time treatment cost for SDWLHQWVZLWK1'2DQG,'2ZDV $YHUDJHWUHDWPHQWFRVWRIDQ ,QWUDGHWUXVRULQMHFWLRQRI%R17$ZDVDQGIRUSDWLHQWV ZLWK1'2DQG,'2%DVHGRQPRQWKGXUDWLRQRIHI¿FDF\WKHPRQWKO\ FRVW IRU 616 ZDV %R17$ PRQWKO\ FRVW EDVHG RQ PRQWK GXUDWLRQRIHI¿FDF\DFURVVSDWLHQWVZLWK1'2DQG,'2ZDVDQG UHVSHFWLYHO\7KH¿UVW\HDUDYHUDJH616FRVWH[FHHGHGWKH¿UVW \HDUDYHUDJH%R17$LQMHFWLRQFRVWE\ DQG LQSDWLHQWV with NDO and IDO respectively. CONCLUSIONS: The one time treatment cost as well DV WKH ¿UVW \HDU FRVW IRU 616 ZDV PDUNHGO\ JUHDWHU WKDQ WKRVH IRU BoNTA intra-detrusor injections for OAB. These cost differences should be incorporated into a comprehensive health care technology assessment. Source of Funding: Allergan, Inc.
158 DESMOPRESSIN TREATMENT IS MORE COST-EFFECTIVE THAN BEHAVIOURAL TREATMENT IN ADULTS SUFFERING FROM NOCTURIA WHEN APPLYING A SOCIETAL PERSPECTIVE Tove Holm-Larsen*, Jan Sorensen, Ebba H Hansen, Jens P Norgaard. Copenhagen, Denmark, and Odense, Denmark. ,1752'8&7,21$1' 2%-(&7,9( 1RFWXULD GH¿QHG DV JHWWLQJ XS DW QLJKW WR YRLG DIWHU D SHULRG RI VOHHS KDV D VLJQL¿FDQW negative impact on quality of life (QoL). This is due to many factors, particularly the interruption of sleep. Nocturia is often considered to be an inevitable part of growing old and may therefore be untreated or addressed through simple behavioural changes. Desmopressin has been clinically proven as an effective treatment option for nocturia. Given that society’s healthcare resources are often scarce, it is necessary to consider whether or not the QoL gained with desmopressin therapy is MXVWL¿HGE\WKHHFRQRPLFFRVW7KHUHIRUHRXUREMHFWLYHZDVWRLQYHVWLJDWH whether desmopressin is a cost-effective treatment option for nocturia compared with behavioural changes as measured by quality adjusted life years (QALY) and incremental cost effectiveness ratio (ICER). METHODS: Data were extracted from three randomised controlled trials, three long-term follow-up studies and one survey, incorporating a total of 1110 patients. The health economic model, a decision tree, was based on average number of night-time voids, QoL and the work productivity of patients suffering from nocturia. The economic calculations included price of medication and physician visits. Calculations were also performed to include the increase in productivity provided by desmopressin treatment. RESULTS: The ICER of desmopressin compared with behavioural changes was €985 and €998 per QALY for men and women respectively when focusing on direct costs, i.e. it costs €985 more to obtain a year of full QoL when treating with desmopressin compared to behavioural changes alone. When considering the societal perspective by including the improved productivity due to treatment, the incremental cost of behavioural changes was €819 for men and €351 for women. CONCLUSIONS: The direct costs of desmopressin may be greater than the costs for behavioural changes. However, treatment of nocturia with desmopressin has been shown to increase productivity and QoL. When these features are included in a health economic
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
calculation, desmopressin generates a higher QoL at a lower cost than behavioural changes. Source of Funding: This abstract is part of a PhD study at University of Copenhagen. The PhD study is supported by a grant from Ferring Pharmaceuticals A/S.
159 OPERATING ROOM COST ANALYSIS: A SURVEY OF COST AWARENESS AMONG UROLOGIC SURGERY STAFF Ted A Skolarus*, Robert L Grubb, Thomas M Connor, Gerald L Andriole, Sam B Bhayani. St. Louis, MO. INTRODUCTION AND OBJECTIVE: The variety of medical devices and instruments in the operating room (OR) continues to LQFUHDVH7KH¿QDQFLDOLPSDFWRIXVLQJWKHVHQHZGHYLFHVLVXQNQRZQ The extent to which awareness of OR item cost affects the use of various OR devices and the total costs of surgical care is unknown. To determine cost awareness among members of the urologic OR team, we surveyed urologic OR nurses, urology residents and attending physicians concerning their estimates of the suggested retail price in U.S. dollars for 50 commonly used OR items. METHODS: Fifty commonly used urologic OR items were selected for analysis. Items included: sutures, accessories, anesthesia cost per minute, endoscopic items, hemostatic agents, laparoscopic and RSHQGLVSRVDEOHLQVWUXPHQWVUDQJLQJLQSULFHIURPWR6XUYH\V were distributed at a single academic institution to urologic surgery OR nurses, residents and attending staff. Data were compiled for each group. Total cost predictions for all items were calculated by group and compared to manufacturer retail price as a percent difference. RESULTS: Thirty-two surveys were completed. Eleven attending urologists, 9 urology residents and 12 urologic OR nurses FRPSOHWHGWKHVXUYH\7RWDOUHWDLOFRVWRIDOO25LWHPVZDV7KH PHGLDQ FRVW HVWLPDWH IRU DOO SDUWLFLSDQWV ZDV 37% less than retail cost. Median urology attending estimations were the most inaccurate (45%) followed by urology resident (36%) and urologic OR nursing staff (26%). Urologic OR Cost Estimations Urologic group
Median cost estimate
Attending Resident OR Nurse
Difference from retail cost
Percent difference from retail cost 45% 36% 26%
CONCLUSIONS: Overall awareness of urologic OR item costs is inadequate. Operating room expenditures are grossly underestimated in this small sample by 26 - 45%. Also, wide variability exists among estimates of individuals directly participating in urologic surgical care regarding controllable costs of disposable OR items. Education regarding the cost of various OR commodities may be a method to decrease OR costs. Source of Funding: None
160 IS SECOND LOOK FLEXIBLE NEPHROSCOPY FOLLOWING PERCUTANEOUS NEPHROSTOLITHOTOMY COST EFFECTIVE? Jay D Raman*, Aditya Bagrodia, Karim Bensalah, Jeffrey A Cadeddu, Margaret S Pearle, Yair Lotan. Dallas, TX. INTRODUCTION AND OBJECTIVE: While percutaneous nephrostolithotomy (PCNL) is highly effective for the treatment of complex renal calculi, a fraction of patients will be left with residual stone fragments (RF) after the initial procedure. At many centers, second look ÀH[LEOHQHSKURVFRS\ )1 LVQRWURXWLQHO\SHUIRUPHGDIWHU3&1/EHFDXVH VPDOOUHVLGXDOIUDJPHQWVDUHFRQVLGHUHGFOLQLFDOO\LQVLJQL¿FDQWDQGWKH procedure not viewed as cost effective. To address this, we calculated the cost of stone-related events directly attributable to RF after PCNL. METHODS: We reviewed 527 patients who underwent PCNL EHWZHHQ$SULO DQG-DQXDU\DQGLGHQWL¿HGSDWLHQWVZLWK evidence of RF on post-operative computed tomography (CT) who did not undergo second look FN. The primary study endpoint was identifed DVDVWRQHUHODWHGHYHQWGH¿QHGDV V\PSWRPDWLFRUDV\PSWRPDWLF growth of the RF on follow-up imaging studies or 2) need for emergency
THE JOURNAL OF UROLOGY®
METHODS: SNS billing codes for procedures, durable medical equipment (DME), and hospital admission were derived from commonly billed codes issued to providers by the SNS manufacturer. IIntra-detrusor injection of BoNTA billing codes were based on recommended BoNTAVSHFL¿FFRGHVIRU2$%IURPDODUJHKHDOWKSODQ3URFHGXUHFRVWVZHUH based on the Center for Medicare and Medicaid Services (CMS) National Physician Fee Schedule Relative Value File. DME costs were based on the CMS DME Point-of-Service Fee Schedule. BoNTA drug cost was calculated using CMS Average Selling Price assuming 300 units of BoNTA for NDO and 200 units for IDO patients. SNS hospital admission costs were based on CMS DRG price schedules. Although uncertainty H[LVWVLQWKHGXUDWLRQRIHI¿FDF\ZHDVVXPHGDQDYHUDJHRIDPRQWK duration for SNS and 6-month duration for BoNTA in order to estimate ¿UVW\HDUFRVWV$OOFRVWVZHUHUHSRUWHGLQ86GROODUV RESULTS: The average SNS one time treatment cost for SDWLHQWVZLWK1'2DQG,'2ZDV $YHUDJHWUHDWPHQWFRVWRIDQ ,QWUDGHWUXVRULQMHFWLRQRI%R17$ZDVDQGIRUSDWLHQWV ZLWK1'2DQG,'2%DVHGRQPRQWKGXUDWLRQRIHI¿FDF\WKHPRQWKO\ FRVW IRU 616 ZDV %R17$ PRQWKO\ FRVW EDVHG RQ PRQWK GXUDWLRQRIHI¿FDF\DFURVVSDWLHQWVZLWK1'2DQG,'2ZDVDQG UHVSHFWLYHO\7KH¿UVW\HDUDYHUDJH616FRVWH[FHHGHGWKH¿UVW \HDUDYHUDJH%R17$LQMHFWLRQFRVWE\ DQG LQSDWLHQWV with NDO and IDO respectively. CONCLUSIONS: The one time treatment cost as well DV WKH ¿UVW \HDU FRVW IRU 616 ZDV PDUNHGO\ JUHDWHU WKDQ WKRVH IRU BoNTA intra-detrusor injections for OAB. These cost differences should be incorporated into a comprehensive health care technology assessment. Source of Funding: Allergan, Inc.
158 DESMOPRESSIN TREATMENT IS MORE COST-EFFECTIVE THAN BEHAVIOURAL TREATMENT IN ADULTS SUFFERING FROM NOCTURIA WHEN APPLYING A SOCIETAL PERSPECTIVE Tove Holm-Larsen*, Jan Sorensen, Ebba H Hansen, Jens P Norgaard. Copenhagen, Denmark, and Odense, Denmark. ,1752'8&7,21$1' 2%-(&7,9( 1RFWXULD GH¿QHG DV JHWWLQJ XS DW QLJKW WR YRLG DIWHU D SHULRG RI VOHHS KDV D VLJQL¿FDQW negative impact on quality of life (QoL). This is due to many factors, particularly the interruption of sleep. Nocturia is often considered to be an inevitable part of growing old and may therefore be untreated or addressed through simple behavioural changes. Desmopressin has been clinically proven as an effective treatment option for nocturia. Given that society’s healthcare resources are often scarce, it is necessary to consider whether or not the QoL gained with desmopressin therapy is MXVWL¿HGE\WKHHFRQRPLFFRVW7KHUHIRUHRXUREMHFWLYHZDVWRLQYHVWLJDWH whether desmopressin is a cost-effective treatment option for nocturia compared with behavioural changes as measured by quality adjusted life years (QALY) and incremental cost effectiveness ratio (ICER). METHODS: Data were extracted from three randomised controlled trials, three long-term follow-up studies and one survey, incorporating a total of 1110 patients. The health economic model, a decision tree, was based on average number of night-time voids, QoL and the work productivity of patients suffering from nocturia. The economic calculations included price of medication and physician visits. Calculations were also performed to include the increase in productivity provided by desmopressin treatment. RESULTS: The ICER of desmopressin compared with behavioural changes was €985 and €998 per QALY for men and women respectively when focusing on direct costs, i.e. it costs €985 more to obtain a year of full QoL when treating with desmopressin compared to behavioural changes alone. When considering the societal perspective by including the improved productivity due to treatment, the incremental cost of behavioural changes was €819 for men and €351 for women. CONCLUSIONS: The direct costs of desmopressin may be greater than the costs for behavioural changes. However, treatment of nocturia with desmopressin has been shown to increase productivity and QoL. When these features are included in a health economic
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
calculation, desmopressin generates a higher QoL at a lower cost than behavioural changes. Source of Funding: This abstract is part of a PhD study at University of Copenhagen. The PhD study is supported by a grant from Ferring Pharmaceuticals A/S.
159 OPERATING ROOM COST ANALYSIS: A SURVEY OF COST AWARENESS AMONG UROLOGIC SURGERY STAFF Ted A Skolarus*, Robert L Grubb, Thomas M Connor, Gerald L Andriole, Sam B Bhayani. St. Louis, MO. INTRODUCTION AND OBJECTIVE: The variety of medical devices and instruments in the operating room (OR) continues to LQFUHDVH7KH¿QDQFLDOLPSDFWRIXVLQJWKHVHQHZGHYLFHVLVXQNQRZQ The extent to which awareness of OR item cost affects the use of various OR devices and the total costs of surgical care is unknown. To determine cost awareness among members of the urologic OR team, we surveyed urologic OR nurses, urology residents and attending physicians concerning their estimates of the suggested retail price in U.S. dollars for 50 commonly used OR items. METHODS: Fifty commonly used urologic OR items were selected for analysis. Items included: sutures, accessories, anesthesia cost per minute, endoscopic items, hemostatic agents, laparoscopic and RSHQGLVSRVDEOHLQVWUXPHQWVUDQJLQJLQSULFHIURPWR6XUYH\V were distributed at a single academic institution to urologic surgery OR nurses, residents and attending staff. Data were compiled for each group. Total cost predictions for all items were calculated by group and compared to manufacturer retail price as a percent difference. RESULTS: Thirty-two surveys were completed. Eleven attending urologists, 9 urology residents and 12 urologic OR nurses FRPSOHWHGWKHVXUYH\7RWDOUHWDLOFRVWRIDOO25LWHPVZDV7KH PHGLDQ FRVW HVWLPDWH IRU DOO SDUWLFLSDQWV ZDV 37% less than retail cost. Median urology attending estimations were the most inaccurate (45%) followed by urology resident (36%) and urologic OR nursing staff (26%). Urologic OR Cost Estimations Urologic group
Median cost estimate
Attending Resident OR Nurse
Difference from retail cost
Percent difference from retail cost 45% 36% 26%
CONCLUSIONS: Overall awareness of urologic OR item costs is inadequate. Operating room expenditures are grossly underestimated in this small sample by 26 - 45%. Also, wide variability exists among estimates of individuals directly participating in urologic surgical care regarding controllable costs of disposable OR items. Education regarding the cost of various OR commodities may be a method to decrease OR costs. Source of Funding: None
160 IS SECOND LOOK FLEXIBLE NEPHROSCOPY FOLLOWING PERCUTANEOUS NEPHROSTOLITHOTOMY COST EFFECTIVE? Jay D Raman*, Aditya Bagrodia, Karim Bensalah, Jeffrey A Cadeddu, Margaret S Pearle, Yair Lotan. Dallas, TX. INTRODUCTION AND OBJECTIVE: While percutaneous nephrostolithotomy (PCNL) is highly effective for the treatment of complex renal calculi, a fraction of patients will be left with residual stone fragments (RF) after the initial procedure. At many centers, second look ÀH[LEOHQHSKURVFRS\ )1 LVQRWURXWLQHO\SHUIRUPHGDIWHU3&1/EHFDXVH VPDOOUHVLGXDOIUDJPHQWVDUHFRQVLGHUHGFOLQLFDOO\LQVLJQL¿FDQWDQGWKH procedure not viewed as cost effective. To address this, we calculated the cost of stone-related events directly attributable to RF after PCNL. METHODS: We reviewed 527 patients who underwent PCNL EHWZHHQ$SULO DQG-DQXDU\DQGLGHQWL¿HGSDWLHQWVZLWK evidence of RF on post-operative computed tomography (CT) who did not undergo second look FN. The primary study endpoint was identifed DVDVWRQHUHODWHGHYHQWGH¿QHGDV V\PSWRPDWLFRUDV\PSWRPDWLF growth of the RF on follow-up imaging studies or 2) need for emergency