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PD14-09 IDENTIFYING PATIENTS WITH MICROHEMATURIA AT RISK FOR A MISSED OR DELAYED DIAGNOSIS: WHO IS NOT BEING EVALUATED IN A TIMELY FASHION?
THE JOURNAL OF UROLOGYâ
e280
RESULTS: We identified 165,387 patients representing a weighted total of 1,097,355 patients from 490 hospitals. 30,063 (2.7%) experienced post-operative delirium. The greatest incidence occurred after RC, with 6,268 cases (11%). After adjusting for patient, hospital, and peri-operative characteristics, patients with post-operative delirium had greater odds of in-hospital mortality (OR 3.65; 95% CI 2.56-5.22; p <0.001), 90-day mortality (OR 1.47; 95% CI 1.08-1.99; p ¼ 0.013), discharge with home healthcare (OR 2.25; 95% CI 1.94-2.61; p <0.001), discharge to skilled nursing facilities (OR 4.64; 95% CI, 3.935.48; p <0.001), and an increase in median LOS by 0.9 days (95% CI 0.84-0.96; p <0.001). Patients with post-operative delirium also had an increase in direct hospital costs by $2,697 (95% CI, $2,250-$3,144; p <0.001). When stratified by type of surgery, the greatest difference in cost was seen in patients following RC ($30,859 vs. $26,607; p<0.001). The largest driver of costs was in room and board across all surgeries (p<0.001). CONCLUSIONS: Patients with post-operative delirium experience worse outcomes, prolonged LOS, and increased admission costs following major urologic cancer surgeries. In particular, the largest incidence and costs occurred in delirious patients after RC. Further research is warranted in order to identify high-risk patients and devise preventive strategies.
Source of Funding: None
PD14-09 IDENTIFYING PATIENTS WITH MICROHEMATURIA AT RISK FOR A MISSED OR DELAYED DIAGNOSIS: WHO IS NOT BEING EVALUATED IN A TIMELY FASHION?
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
complete evaluation within 1 year (Table 1). Of patients who had a documented complete evaluation 5.7% (n¼27), 2.3% (n¼11), and 14.3% (n¼67) were diagnosed with bladder cancer, kidney cancer, and urolithiasis, respectively. CONCLUSIONS: Few patients complete a timely evaluation for their MH. Hematuria severity and male sex are significantly associated with a higher likelihood of receiving a complete MH evaluation.
Source of Funding: Research reported in this abstract was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
PD14-10 COST-EFFECTIVENESS OF COMMON DIAGNOSTIC APPROACHES FOR EVALUATION OF ASYMPTOMATIC MICROSCOPIC HEMATURIA
Richard Matulewicz*, Jason Cohen, John Oliver DeLancey, Joshua Meeks, Chicago, IL
Joshua Halpern*, Bilal Chughtai, New York, NY; Hassan Ghomrawi, Chicago, IL
INTRODUCTION AND OBJECTIVES: Many patients with microhematuria (MH) do not complete the recommended evaluation: cystoscopy and genitourinary imaging. These patients are therefore at risk of a missed or delayed diagnosis. We sought to determine factors associated with a lower likelihood of completing a MH evaluation in a large health system as a step toward targeted quality improvement efforts. METHODS: Patients 35 and older with a new diagnosis of MH (>3 RBC/hpf) in the absence of a benign cause were included. Data was source from our multi-center enterprise data warehouse during the years 2012-2015. Demographic and urinalysis (UA) data as well as details about the timing and completion of cystoscopy and appropriate imaging were collected. Regression modeling was used to determine factors associated with completing the MH evaluation within 1 year. RESULTS: In total, 7,888 patients were included: 1,191 (15.1%) had a partial evaluation and 470 (6.0%) underwent a complete evaluation. Median days to complete evaluation was 77 [IQR 35-235]. Of those who had a partial evaluation, 37.1% had a cystoscopy and 62.9% had an imaging study. Younger patients, male patients, those with more severe MH on index UA, and those with a positive follow up UA all had higher unadjusted rates of evaluation. After adjusting for all covariates, male sex (OR 1.27, 95% CI 1.01-1.58), increasing MH severity on index UA (more RBC/hpf), and positive follow up UA (OR 3.21, 95% CI 2.495.14) but not age were significantly associated with receiving a
INTRODUCTION AND OBJECTIVES: Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignancy. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignancy among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. We sought to estimate the effectiveness, costs, and incremental cost-effectiveness ratio (ICER) for common diagnostic approaches evaluating AMH. METHODS: We performed cost-effectiveness analysis using a decision-analytic model with inputs from the medical literature. Four diagnostic approaches were evaluated relative to the reference case of no evaluation: computed tomography (CT) alone; cystoscopy alone; CT and cystoscopy combined; and renal ultrasound (US) and cystoscopy combined. The index patient was an adult with AMH on urinalysis. Primary outcomes were cancers detected and costs per 10,000 patients evaluated, and ICERs. RESULTS: CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9,300,000. US and cystoscopy detected 245 cancers and was most cost-effective with an ICER of $53,810 per cancer detected. Replacing US with CT detected just 1 additional cancer at an ICER of $6,380,484 per cancer detected. US and cystoscopy remained the most cost-effective approach in subgroup analysis.
e280
RESULTS: We identified 165,387 patients representing a weighted total of 1,097,355 patients from 490 hospitals. 30,063 (2.7%) experienced post-operative delirium. The greatest incidence occurred after RC, with 6,268 cases (11%). After adjusting for patient, hospital, and peri-operative characteristics, patients with post-operative delirium had greater odds of in-hospital mortality (OR 3.65; 95% CI 2.56-5.22; p <0.001), 90-day mortality (OR 1.47; 95% CI 1.08-1.99; p ¼ 0.013), discharge with home healthcare (OR 2.25; 95% CI 1.94-2.61; p <0.001), discharge to skilled nursing facilities (OR 4.64; 95% CI, 3.935.48; p <0.001), and an increase in median LOS by 0.9 days (95% CI 0.84-0.96; p <0.001). Patients with post-operative delirium also had an increase in direct hospital costs by $2,697 (95% CI, $2,250-$3,144; p <0.001). When stratified by type of surgery, the greatest difference in cost was seen in patients following RC ($30,859 vs. $26,607; p<0.001). The largest driver of costs was in room and board across all surgeries (p<0.001). CONCLUSIONS: Patients with post-operative delirium experience worse outcomes, prolonged LOS, and increased admission costs following major urologic cancer surgeries. In particular, the largest incidence and costs occurred in delirious patients after RC. Further research is warranted in order to identify high-risk patients and devise preventive strategies.
Source of Funding: None
PD14-09 IDENTIFYING PATIENTS WITH MICROHEMATURIA AT RISK FOR A MISSED OR DELAYED DIAGNOSIS: WHO IS NOT BEING EVALUATED IN A TIMELY FASHION?
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
complete evaluation within 1 year (Table 1). Of patients who had a documented complete evaluation 5.7% (n¼27), 2.3% (n¼11), and 14.3% (n¼67) were diagnosed with bladder cancer, kidney cancer, and urolithiasis, respectively. CONCLUSIONS: Few patients complete a timely evaluation for their MH. Hematuria severity and male sex are significantly associated with a higher likelihood of receiving a complete MH evaluation.
Source of Funding: Research reported in this abstract was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
PD14-10 COST-EFFECTIVENESS OF COMMON DIAGNOSTIC APPROACHES FOR EVALUATION OF ASYMPTOMATIC MICROSCOPIC HEMATURIA
Richard Matulewicz*, Jason Cohen, John Oliver DeLancey, Joshua Meeks, Chicago, IL
Joshua Halpern*, Bilal Chughtai, New York, NY; Hassan Ghomrawi, Chicago, IL
INTRODUCTION AND OBJECTIVES: Many patients with microhematuria (MH) do not complete the recommended evaluation: cystoscopy and genitourinary imaging. These patients are therefore at risk of a missed or delayed diagnosis. We sought to determine factors associated with a lower likelihood of completing a MH evaluation in a large health system as a step toward targeted quality improvement efforts. METHODS: Patients 35 and older with a new diagnosis of MH (>3 RBC/hpf) in the absence of a benign cause were included. Data was source from our multi-center enterprise data warehouse during the years 2012-2015. Demographic and urinalysis (UA) data as well as details about the timing and completion of cystoscopy and appropriate imaging were collected. Regression modeling was used to determine factors associated with completing the MH evaluation within 1 year. RESULTS: In total, 7,888 patients were included: 1,191 (15.1%) had a partial evaluation and 470 (6.0%) underwent a complete evaluation. Median days to complete evaluation was 77 [IQR 35-235]. Of those who had a partial evaluation, 37.1% had a cystoscopy and 62.9% had an imaging study. Younger patients, male patients, those with more severe MH on index UA, and those with a positive follow up UA all had higher unadjusted rates of evaluation. After adjusting for all covariates, male sex (OR 1.27, 95% CI 1.01-1.58), increasing MH severity on index UA (more RBC/hpf), and positive follow up UA (OR 3.21, 95% CI 2.495.14) but not age were significantly associated with receiving a
INTRODUCTION AND OBJECTIVES: Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignancy. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignancy among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. We sought to estimate the effectiveness, costs, and incremental cost-effectiveness ratio (ICER) for common diagnostic approaches evaluating AMH. METHODS: We performed cost-effectiveness analysis using a decision-analytic model with inputs from the medical literature. Four diagnostic approaches were evaluated relative to the reference case of no evaluation: computed tomography (CT) alone; cystoscopy alone; CT and cystoscopy combined; and renal ultrasound (US) and cystoscopy combined. The index patient was an adult with AMH on urinalysis. Primary outcomes were cancers detected and costs per 10,000 patients evaluated, and ICERs. RESULTS: CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9,300,000. US and cystoscopy detected 245 cancers and was most cost-effective with an ICER of $53,810 per cancer detected. Replacing US with CT detected just 1 additional cancer at an ICER of $6,380,484 per cancer detected. US and cystoscopy remained the most cost-effective approach in subgroup analysis.