Login to Access Video or Poster Abstract: MP66-08
Sources of Funding: None

Introduction

Cryptorchidism is the most common genitourinary disorder identified in neonates affecting up to 3.7% of males. Ultrasound (US) is often used inappropriately following clinical diagnosis in attempts to locate the testis. Extensive evidence based research demonstrates the unreliability and poor sensitivity/specificity of scrotal US in cryptorchid males. The American Urologic Association in conjunction with the Choosing Wisely&[copy] initiative released a statement against ordering of US in males with cryptorchidism on February 21st, 2013. Our objective is to assess trends in the rates of US use after publication of the 2013 recommendation.

Methods

We utilized the Truven Health Analytics MarketScan® Research Database of commercially insured children to identify a cohort of children with a diagnosis code for undescended (752.51) and retractile testes (752.52) during an outpatient encounter in 2010-2014. Using CPT codes for scrotal US (76870) and for duplex scan of scrotal contents (93975/93976), males aged 0-12 were identified to isolate a primarily pre-pubertal population. The primary outcome measured was rate of US usage before and after the guideline release date. Cases were subcategorized according to geographic region. Out of pocket costs were determined and the average additional expense for US visits were calculated.

Results

We identified 52,804 outpatient encounters for undescended or retractile testes, of which, 9771 (19%) were associated with a scrotal US between 2010-2014. From 2010-2012 US was used in 6367/33,995 patients (18.7%). Following the guideline implementation the rate was 18.7% (1666/8890) in 2013 and 17.5% (1738/9919) in 2014. In this time period, the highest rate of visits associated with US were found in the West (22%), while the remaining regions had frequencies of 15-19%. Patients received an average of 1.8 tests (±1), with a range of 1 to 16. The average out-of-pocket cost for an US was $115 (±$202).

Conclusions

Following release of the Choosing Wisely&[copy] initiative, there was a small national reduction in rates of inappropriate US imaging for commercially insured pre-pubertal boys with the diagnosis of undescended or retractile testes. A significant proportion of the population continues to receive unnecessary imaging studies without clinical indication resulting in significant financial burden to the consumer and to the healthcare system as a whole. Continued efforts should be made to educate primary physicians on the poor utility of scrotal US in cryptorchid males.

Funding

None