Models of Care for Vesicoureteral Reflux With and Without an End Point of Reflux Resolution: A Computer Cost Analysis

Abstract

Accepted for publication December 14, 2012. AS providers increasingly believe in a more benign natural history of childhood vesicoureteral reflux, many have adopted a noninterventional approach, reserving aggressive therapy for select patients. On the other hand, the availability of subureteral injection has caused many to question whether indications for correction of vesicoureteral reflux should be more liberal than in the past. Options for VUR correction include open reimplantation and laparoscopic or robotic operations that replicate open reimplantation. Unlike the other minimally invasive options, dextranomer/ hyaluronic acid injection is well established in the treatment of VUR, offering an outpatient and virtually pain-free alternative to open surgery. However, this approach is controversial, and reported early and long-term success rates vary widely. We previously used a population model based on a theoretical cohort of girls with VUR followed for 5 years to examine surgical timing, impact of bladder dysfunction on cost of treatment, and dextranomer/hyaluronic acid injection success rates necessary to achieve cost equivalence to open surgical and standard treatment paradigms. With time costs have changed, as have attitudes toward what constitutes standard management. In particular practitioners are increasingly inclined to observe VUR, or to