Abstract: PD14-10
Sources of Funding: None

Introduction

Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignancy. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignancy among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. We sought to estimate the effectiveness, costs, and incremental cost-effectiveness ratio (ICER) for common diagnostic approaches evaluating AMH.

Methods

We performed cost-effectiveness analysis using a decision-analytic model with inputs from the medical literature. Four diagnostic approaches were evaluated relative to the reference case of no evaluation: computed tomography (CT) alone; cystoscopy alone; CT and cystoscopy combined; and renal ultrasound (US) and cystoscopy combined. The index patient was an adult with AMH on urinalysis. Primary outcomes were cancers detected and costs per 10,000 patients evaluated, and ICERs.

Results

CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9,300,000. US and cystoscopy detected 245 cancers and was most cost-effective with an ICER of $53,810 per cancer detected. Replacing US with CT detected just 1 additional cancer at an ICER of $6,380,484 per cancer detected. US and cystoscopy remained the most cost-effective approach in subgroup analysis._x000D_ _x000D_ The model was not sensitive to any inputs within the proposed ranges. Using probabilistic sensitivity analysis, US and cystoscopy was the dominant strategy in 100% of simulations._x000D_

Conclusions

The combination of renal US and cystoscopy is most cost-effective among four approaches for the initial evaluation of AMH. The use of US in lieu of CT as first-line will reduce the morbidity and costs associated with evaluation of AMH. Given these findings, urologists must critically evaluate the appropriateness of our current clinical guidelines to reflect the most effective screening strategies for patients with AMH.

Funding

None