The economic implications of unsuspected findings from CT urography performed for haematuria

Abstract

Objectives: We set out to determine the prevalence of unsuspected findings from CT urography (CTU) performed for haematuria and to evaluate the economic implications associated with the subsequent management of these findings. Methods: We analysed the results of 778 consecutive CTU scans performed in a haematuria clinic between 2008 and 2010. We excluded cases where diagnosis of an abnormality had been made prior to CTU. Costs incurred during the follow-up of unsuspected findings were calculated following guidance set out in the NHS Costing Manual 2009/10. Results: 778 CTU scans were performed for patients attending a haematuria clinic from 2008 to 2010. 455 men and 323 women underwent CTU scan; they had a median age of 62 years. 56% of scans were found to have unexpected extra-urinary findings (587 abnormalities in 439 scans). Common findings included diverticular disease (138, 17.7%), adrenal masses [85, 10.9%; 40 (5.1%) of which were indeterminate], lung abnormalities (67, 8.6%), gall bladders containing calculi (44, 5.7%), adnexal cysts (25, 7.7% of women) and aortic aneurysms (18, 2.3%). These findings led to a total of 136 outpatient appointments, 88 radiological investigations and 11 procedures (4 of which were major). The overall cost incurred was £47 366, or £60 per patient. Conclusion: CTU is associated with a high rate of unsuspected findings. There is an economic implication to performing CT scanning in this setting, in which further unanticipated investigation and treatment cost is approximately £60 per patient.

Yield of Urinary Tract Cancer Diagnosis With Repeat CT Urography in Patients With Hematuria

“…CTU is a more expensive examination [18] and involves a higher radiation exposure to the patient [19]. Additional concerns regarding the use of CTU include potential nephrotoxic or allergic adverse reactions to IV contrast material and the cost and potential morbidity related to incidental findings [20,21]. Patients with hematuria who have under-H ematuria is a common problem, affecting 0.…”

Assessing the Costs of Extraurinary Findings of Computed Tomography Urogram in the Evaluation of Asymptomatic Microscopic Hematuria

“…Again, this is similar to previous studies, which reported such findings in 11%-15% of their patient population. [9][10][11] The similarity between results is interesting, considering that each study used different classifications of clinical importance for incidental findings. Whereas no standard classification system exists for CTU incidental findings, many of these studies are based on systems used in studies evaluating incidental extracolonic findings on CT colonography.…”

“…5,7 The use of CTU also commonly reveals incidental extraurinary findings of which a small number are clinically significant. [9][10][11][12] This may lead to additional and ultimately negative workups. 11 Previous studies have evaluated the costs of incidental CTU findings in the evaluation of gross hematuria.…”

“…11 Previous studies have evaluated the costs of incidental CTU findings in the evaluation of gross hematuria. 9,11,12 We recognize that incidental findings would also be a problem in the evaluation of AMH. Furthermore, the AMH evaluation is commonly negative so detection of incidental findings is even more problematic.…”

Investigation of two week wait referred haematuria patients in the UK: A national survey

“…In the study by Cauberg et al 30 over one in four patients undergoing a CTU for haematuria had an incidentaloma, with 14.4% being life threatening. The economic cost to the NHS in the study by Bromage et al 31 was £60 per incidentaloma. In our opinion poll 62% of clinicians felt that CTU should be the first line investigation for VH with just over half surveyed feeling unconcerned by its implementation in haematuria clinics.…”