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

Abstract

Objective To determine which factors are associated with higher urethroplasty procedural costs and whether they have been increasing or decreasing 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 costs was $7321 ($5677–$10000). Patients with multiple comorbid conditions were associated with extreme costs (OR 1.56 95% CI 1.19–2.04, p=0.02) compared to patients with no comorbid disease. Inpatient complications raised the odds of extreme costs OR 3.2 CI 2.14–4.75, p<0.001). Graft urethroplasties were associated with extreme costs (OR 1.78 95% CI 1.2–2.64, p=0.005). Variation in patient age, race, hospital region, bed size, teaching status, payer 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.

Cost-effective Strategies for the Management and Treatment of Urethral Stricture Disease

“…With extreme costs defined as the top 20th percentile of expenditure, the investigators found that patients with multiple comorbid diseases were associated with increased costs (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.19-2.04, P 5 .02). 25 Inpatient complications increased the odds of extreme costs (OR 3.2 95% CI 2.14-4.75, P <.001), as did graft urethroplasties (OR 1.78, 95% CI 1.2-2.64, P 5 .005). Interestingly, the investigators did not find any differences in extreme costs based on patient age, race, hospital region, bed size, teaching status, payer type, and volume of urethroplasty cases.…”

“…Although most endoscopic management of USD is performed in an outpatient setting, most urethroplasties performed in the United States are done with either a short stay or inpatient hospital admission. 25 Associated costs with hospital admission may challenge up-front urethroplasty over an initial DVIU attempt. Characterizing hospital costs associated with urethroplasty may better identify the major drivers of hospital costs associated with USD.…”

“…To gain a more granular assessment of inpatient costs associated with urethroplasty, Harris and colleagues 25 used the same data set but captured hospital charges relating to USD. Over the investigators' study period, a total of 2298 urethroplasties were performed with a median hospital cost of $7321.…”

The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy

“…24,25 Information captured in the NIS database is well described, 24 and multiple studies have used it to investigate hospital-level variations in surgical outcomes, 24,26 cost, 24,27 and accessibility. The NIS, furnished by the Agency for Healthcare Research and Quality, is the largest collection of all-payer, inpatient administrative data in the United States.…”

“…The NIS, furnished by the Agency for Healthcare Research and Quality, is the largest collection of all-payer, inpatient administrative data in the United States. 24,25 Information captured in the NIS database is well described, 24 and multiple studies have used it to investigate hospital-level variations in surgical outcomes, 24,26 cost, 24,27 and accessibility. 28…”