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• W2015507893 abstract "No AccessJournal of UrologyPediatric Urology1 Oct 2011Screening for Malignancy After Augmentation Cystoplasty in Children With Spina Bifida: A Decision Analysis Paul J. Kokorowski, Jonathan C. Routh, Joseph G. Borer, Carlos R. Estrada, Stuart B. Bauer, and Caleb P. Nelson Paul J. KokorowskiPaul J. Kokorowski Supported by Grant T32-DK60442 from the National Institute of Diabetes and Digestive and Kidney Diseases. More articles by this author , Jonathan C. RouthJonathan C. Routh Supported by Grant T32-HS000063 from the Agency for Healthcare Research and Quality. More articles by this author , Joseph G. BorerJoseph G. Borer More articles by this author , Carlos R. EstradaCarlos R. Estrada More articles by this author , Stuart B. BauerStuart B. Bauer More articles by this author , and Caleb P. NelsonCaleb P. Nelson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.05.065AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Augmentation cystoplasty is the mainstay of surgical treatment for medically refractory neurogenic bladder in patients with spina bifida. Concerns regarding an increased risk of malignancy have prompted many centers to consider routine postoperative screening. We examine the potential cost-effectiveness of such screening. Materials and Methods: A Markov model was used to compare 2 screening strategies among patients with spina bifida after cystoplasty, namely annual screening cystoscopy and cytology and usual care. Model parameters were informed via a systematic review of post-augmentation malignancy and cost estimates from published reports or government sources. Results: In a hypothetical cohort the individual increase in life expectancy for the entire cohort was 2.3 months with an average lifetime cost of $55,200 per capita, for an incremental cost-effectiveness ratio of $273,718 per life-year gained. One-way and two-way sensitivity analyses suggest the screening strategy could be cost effective if the annual rate of cancer development were more than 0.26% (12.8% lifetime risk) or there were a greater than 50% increase in screening effectiveness and cancer risk after augmentation. After adjusting for multiple levels of uncertainty the screening strategy had only an 11% chance of being cost effective at a $100,000 per life-year threshold or a less than 3% chance of being cost effective at $100,000 per quality adjusted life-year. Conclusions: Annual screening for malignancy among patients with spina bifida with cystoplasty using cystoscopy and cytology is unlikely to be cost effective at commonly accepted willingness to pay thresholds. This conclusion is sensitive to a higher than expected risk of malignancy and to highly optimistic estimates of screening effectiveness. References 1 : What is the need for additional bladder surgery after bladder augmentation in childhood?. J Urol2006; 176: 1801. Link, Google Scholar 2 : Augmentation cystoplasty rates at children's hospitals in the United States: a pediatric health information system database study. J Urol2006; 176: 1716. Link, Google Scholar 3 : Secondary malignancies in different forms of urinary diversion using isolated gut. J Urol2004; 172: 831. Link, Google Scholar 4 : Malignancy associated with the use of intestinal segments in the urinary tract. Urol Oncol2007; 25: 165. Google Scholar 5 : The use of annual endoscopy and urine cytology for bladder tumor surveillance following enteric augmentation cystoplasty. J Urol2009; 181: 403. Link, Google Scholar 6 : Villous adenoma in augmentation colocystoplasty: a case report and discussion of the pathogenesis. 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Link, Google Scholar Department of Urology, Children's Hospital Boston and Harvard Pediatric Health Services Research Fellowship Program (JCR), Harvard Medical School, Boston, Massachusetts© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 186Issue 4October 2011Page: 1437-1443 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsurinary bladder, neurogeniccost-benefit analysishealth policyurinary bladder neoplasmsspina bifida cysticaAcknowledgmentsDrs. Steve C. Resch and Jane J. Kim and the Center for Decision Science at Harvard School of Public Health provided valuable input regarding the manuscript.MetricsAuthor Information Paul J. Kokorowski Supported by Grant T32-DK60442 from the National Institute of Diabetes and Digestive and Kidney Diseases. More articles by this author Jonathan C. Routh Supported by Grant T32-HS000063 from the Agency for Healthcare Research and Quality. More articles by this author Joseph G. Borer More articles by this author Carlos R. Estrada More articles by this author Stuart B. Bauer More articles by this author Caleb P. Nelson More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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