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Cost-effectiveness of Routine Postoperative Retrograde Voiding Trials Following Pelvic Surgeries

Wang, Rui MD*; Soeteman, Djøra I. PhD; Hacker, Michele R. ScD*; Lefevre, Roger MD*

Female Pelvic Medicine & Reconstructive Surgery: May 22, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000577
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Objective The aim of this study was to evaluate the cost-effectiveness of retrograde voiding trials in the management of postoperative voiding dysfunction.

Methods We developed a disease simulation model to assess under which conditions routine retrograde voiding trial is the optimal strategy in terms of cost per quality-adjusted life-year and cost per case of chronic voiding dysfunction avoided. We varied the incidence of voiding dysfunction between 2% and 60%. We discounted future costs and utilities at 3% annually. We conducted 1- and 2-way sensitivity analyses on uncertain model parameters.

Results The lifetime analysis showed that when the incidence of postoperative voiding dysfunction exceeded 12.2%, retrograde voiding trials were cost-effective, assuming a willingness-to-pay (WTP) for health of $100,000/quality-adjusted life-year. When the incidence exceeded 31.1%, retrograde voiding trials became the dominant strategy (less costly and more effective). For a simple hysterectomy with voiding dysfunction incidence of approximately 10%, lifetime cost is $230,069/case of chronic voiding dysfunction avoided; for a midurethral sling with voiding dysfunction incidence of approximately 20%, lifetime cost is $60,449/case avoided. Sensitivity analyses showed that WTP for health, the incidence of presentation to the emergency department (ED) for urinary retention and the incidence of chronic urinary retention following treatment in the ED had the greatest impact on the cost-effectiveness results.

Conclusions Routine retrograde voiding trials following pelvic surgery can be cost-effective compared with expectant management when the incidence of voiding dysfunction exceeds 12.2%. These results were sensitive to WTP for health, incidence of ED visits for urinary retention, and incidence of chronic urinary retention following ED visits.

From the *Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School; and †Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA.

Correspondence: Roger Lefevre, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Kirstein 3, Boston, MA 02215. E-mail: rlefevre@bidmc.harvard.edu.

This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers. The funding sources had no involvement in the study design; collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication.

The authors have declared they have no conflicts of interest.

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