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. 2016 Aug:94:246-54.
doi: 10.1016/j.urology.2016.03.044. Epub 2016 Apr 20.

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis With Policy Implications

Catherine R Harris  1 , E Charles Osterberg  1 , Thomas Sanford  1 , Amjad Alwaal  2 , Thomas W Gaither  1 , Jack W McAninch  1 , Charles E McCulloch  3 , Benjamin N Breyer  4
Affiliations

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis With Policy Implications

Catherine R Harris et al. Urology. 2016 Aug.

Abstract

Objective: To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality.

Materials and methods: We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear regression with sensitivity analysis was used to determine variables associated with increased costs. Extreme cost was defined as the top 20th percentile of expenditure, analyzed with logistic regression, and expressed as odds ratios (OR).

Results: A total of 2298 urethroplasties were recorded in NIS over the study period. The median (interquartile range) calculated cost was $7321 ($5677-$10,000). Patients with multiple comorbid conditions were associated with extreme costs [OR 1.56, 95% confidence interval (CI) 1.19-2.04, P = .02] compared with patients with no comorbid disease. Inpatient complications raised the odds of extreme costs (OR 3.2, CI 2.14-4.75, P <.001). Graft urethroplasties were associated with extreme costs (OR 1.78, 95% CI 1.2-2.64, P = .005). Variations in patient age, race, hospital region, bed size, teaching status, payor type, and volume of urethroplasty cases were not associated with extremes of cost.

Conclusion: Cost variation for perioperative inpatient urethroplasty procedures is dependent on preoperative patient comorbidities, postoperative complications, and surgical complexity related to graft usage. Procedural cost and cost variation are critical for understanding which aspects of care have the greatest impact on cost.

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Figures

Fig. 1
Fig. 1
Multivariate analysis of Variables Associated with Extreme Cost (top 20%) Urethroplasty after adjusting for age, race and year
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Rourke KF. Rourke KF. Urology. 2016 Aug;94:254. doi: 10.1016/j.urology.2016.03.046. Epub 2016 Jun 30. Urology. 2016. PMID: 27373986 No abstract available.

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