MP49-11 MEDICAL AND ECONOMIC JUSTIFICATION FOR MINIMALLY INVASIVE SURGERY SPECIFIC TO URINARY STONE DISEASE AT GEORGETOWN PUBLIC HOSPITAL CORPORATION IN GUYANA

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP49-11 MEDICAL AND ECONOMIC JUSTIFICATION FOR MINIMALLY INVASIVE SURGERY SPECIFIC TO URINARY STONE DISEASE AT GEORGETOWN PUBLIC HOSPITAL CORPORATION IN GUYANA Dominique Sherry, Budheshwar Ramsukh, Ava Yap, Chris Prashad, and David Bayne Dominique SherryDominique Sherry More articles by this author , Budheshwar RamsukhBudheshwar Ramsukh More articles by this author , Ava YapAva Yap More articles by this author , Chris PrashadChris Prashad More articles by this author , and David BayneDavid Bayne More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In high income countries, minimally invasive surgery (MIS) to treat urinary stone disease (USD) has demonstrated better health outcomes and lower costs. However, open surgery is still commonplace in low and middle income countries (LMICs) such as Guyana due to inequities in access to equipment, training and resources. We analyzed the current open surgeries for USD at Georgetown Public Hospital Corporation (GPHC) in Guyana and quantified the theoretical change in costs and health outcomes using MIS techniques. METHODS: Case logs of all urology patients at GPHC from January 2018 to July 2022 were retrospectively reviewed. A total of 211 patients with USD were identified and stratified based on procedure. A decision tree analysis was performed to ascertain the cost effectiveness of replacing open surgery with MIS. The analysis included surgical, hospital, complication, transfusion, and convalescence costs. GPHC data was used for hospital length of stay (LOS) and convalescence time. Data on outcome probabilities, hospital costs (scaled for Guyana), life expectancy, complications, transfusion rates and mortality were derived from publications conducted in LMICs similar to Guyana. Disability adjusted life years (DALYs) averted were calculated based on LMIC data and GPHC average patient age. RESULTS: 48% of USD procedures at GPHC were open surgery. Pyelolithotomy was the most common open procedure during the 5-year study period and 51 pyelolithotomy cases were identified that could be replaced by percutaneous nephrolithotomy (PCNL) (50.5% of open cases). A decision tree analysis showed that open surgery was 1.9 times more expensive ($2082 vs $1102) than the replaceable PCNL. A sensitivity analysis showed the higher cost of open surgery was predominantly a result of its longer hospital LOS. A cost effectiveness analysis showed the ICER was in the southeast quadrant of the cost effectiveness plane as PCNL costs $862 less than open surgery for every DALY averted. CONCLUSIONS: This study shows that PCNL is a cost-effective alternative to open surgery at GPHC and demonstrates an opportunity to improve standards of care for urological disease in LMICs. Source of Funding: UCSF School of Medicine Inquiry Funding Office & Harold Varmus Global Heath Scholars Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e682 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dominique Sherry More articles by this author Budheshwar Ramsukh More articles by this author Ava Yap More articles by this author Chris Prashad More articles by this author David Bayne More articles by this author Expand All Advertisement PDF downloadLoading ...