MP15-03 NATIONAL VARIATION IN URETHROPLASTY COST AND PREDICTORS OF EXTREME COST: A COST ANALYSIS WITH POLICY IMPLICATIONS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) I1 Apr 2015MP15-03 NATIONAL VARIATION IN URETHROPLASTY COST AND PREDICTORS OF EXTREME COST: A COST ANALYSIS WITH POLICY IMPLICATIONS Catherine Harris, Amjad Alwaal, Jack McAninch, Charles McCulloch, and Benjamin Breyer Catherine HarrisCatherine Harris More articles by this author , Amjad AlwaalAmjad Alwaal More articles by this author , Jack McAninchJack McAninch More articles by this author , Charles McCullochCharles McCulloch More articles by this author , and Benjamin BreyerBenjamin Breyer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.886AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral stricture disease is common and costly. When compared to endoscopic treatments, urethroplasty has been proven to be a cost-effective approach to manage urethral stricture. Little is known regarding urethroplasty cost variation and what factors are associated with high cost. Our objective was to analyze a national sample of urethroplasty patients to determine what variables were associated with the highest cost. METHODS We conducted a retrospective analysis using the 2001–2010 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample, which is a nationally representative 20% sample of hospitalizations from acute care U.S. hospitals. The NIS captures hospital charges which were converted to cost using the HCUP Cost-to-Charge Ratio. We examined patient, hospital, year, and type of urethroplasty using logistic regression to determine which factors correspond with higher cost, defined as the top quintile. All analyses accommodated the complex sample survey aspects of NIS. RESULTS A total of 2298 urethroplasties were reported in NIS over the study period representing an estimated total 12389 (95% CI 8750–16029) procedures. The median charges were $19866 (IQR $14346-$29382) with associated costs of $7321 ($5677-$10000). Multiple factors were associated with extremes of cost. Patients with any comorbid conditions had increased odds of high cost urethroplasties (OR 1.4, 95% CI 1.1-1.6) compared to those without comorbidities. Patients with 3 or more comorbidities had even higher odds (OR 2.2, 1.3-3.8). Patients with obesity (OR 1.8, 1.2-2.5) and history of renal failure (OR 2.3, 1.2-4.6) were most likely to have extremes of cost compared to other comorbidities. As expected, inpatient complications increased the odds of high hospital costs (OR 2.7, 1.8-3.9), with wound (OR 6.1, 2.6-14.5) and respiratory (5.2, 1.7-15.9) complications increasing the odds of high costs the most. Buccal mucosal graft and use of other graft urethroplasty both increased the odds of high costs by 1.6 (1.0-2.4 and 1.1-2.3, respectively). Extremes of cost were not associated with variations in patient age and race, payer type, hospital size, location, teaching status, region, and volume of urethroplasty cases, and year of urethroplasty. CONCLUSIONS Cost variation for inpatient urethroplasty has policy implications as efforts to bend the healthcare cost curve in the U.S. has led to increased attention and scrutiny of excessive procedural costs. Understanding which aspects of care increase cost can be used to promote targeted cost reduction efforts. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e160 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Harris More articles by this author Amjad Alwaal More articles by this author Jack McAninch More articles by this author Charles McCulloch More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...