Short-term catheter management options for urinary retention following pelvic surgery: a cost analysis

Abstract

Several studies have compared short-term catheterization approaches and have demonstrated no difference in patient satisfaction, but no study has evaluated their costs. To evaluate the costs of 3 pathways for short-term catheter management in patients diagnosed with urinary retention following pelvic surgery. We utilized a Markov decision tree to model costs from the society's perspective. In pathway 1, patients have an indwelling catheter and return to the office for a voiding trial. In pathway 2, patients have an indwelling catheter and discontinue the catheters at home. In pathway 3, patients are taught clean intermittent catheterization postoperatively. We accounted for office visits, emergency department visits, urinary tract infection testing and treatment, transportation, caregiver time, teaching time, and supplies. Clean intermittent catheterization is the least costly catheterization method at $79 per patient, followed by self-removal of the catheter ($128) and office voiding trial ($185). One-way sensitivity analyses showed that the distance between the patient and office and the rates of spontaneous voiding following catheterization had the greatest impact. When patients need to travel >5 miles to the office for catheter removal, self-removal of a catheter is less costly than an office voiding trial. Once it has been determined that patients have urinary retention and require catheterization, clean intermittent catheterization is the most cost-saving option only if the patients are taught clean intermittent catheterization postoperatively. If all patients were to be taught clean intermittent catheterization routinely before surgery, it becomes the most costly option. Based on annual surgical volume, if even $30 were saved per patient with postoperative urinary retention, the estimated total societal savings would be $420,000 to $7.2 million. Clean intermittent catheterization as initial management of urinary retention following pelvic surgery is the most cost-saving option when it is only taught postoperatively to patients after determining the need for catheterization. When this is not possible, self-removal of an indwelling catheter is the most cost-saving option, especially as the distance between the patient and provider increases. Choosing the optimal management guided by patient and provider factors can lead to substantial cost savings annually in the United States.