Cost analysis of the treatment of vesicoureteral reflux: A computer model

Purpose: Surgical intervention for vesicoureteral reflux is generally limit ed to children who have recurrent infection despite adequate antimicrobial prophylaxis or in whom compliance with followup cannot be ensured. In addit ion, surgical therapy is considered in children with persistent reflux afte r a reasonable period of surveillance. We used a model based on the managem ent of a theoretical population of girls with various grades of reflux and followed the costs incurred during a 5-year management period. Materials and Methods: The literature on vesicoureteral reflux was used to create a set of assumptions regarding epidemiology, likelihood of resolutio n, need for operative intervention, risk of infection and appropriate regim en for nonoperative surveillance. These parameters were evaluated in infant s and children as noted in the literature. A 5-year management period was c onsidered. Patients in whom reflux did not resolve with medical management at the end of 5 years were assumed to have undergone surgical correction. C osts were calculated based on the amounts billed, managed care reimbursemen t and Medicaid reimbursement in Maryland. The costs of up front surgical ma nagement were calculated and compared to those of 5 years of standard manag ement. All costs were discounted at a rate of 10%. Results: Calculated costs of standard management were lower for lower grade s than those for higher grades of reflux. The costs of surgical management were lower than those of standard management for higher reflux grades using nondiscounted costs. However, when costs were discounted to present value, the costs of standard management were significantly lower than those of up -front surgery for all scenarios studied. Conclusions: The cost of vesicoureteral reflux is considerable when whole p atient groups are considered. Using cost as the only parameter the standard management of reflux is less costly than up-front surgery. In the individu al surgical intervention usually is predicated by patient and family factor s which were not considered in this model. This computer based construct al lows data from different institutions to be analyzed to project costs of th e management of reflux.