PD65-03 TO STAGE OR NOT TO STAGE? - A COST MINIMIZATION ANALYSIS OF SACRAL NEUROMODULATION PLACEMENT STRATEGIES

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction III (PD65)1 Apr 2019PD65-03 TO STAGE OR NOT TO STAGE? - A COST MINIMIZATION ANALYSIS OF SACRAL NEUROMODULATION PLACEMENT STRATEGIES Andrew Sun*, Catherine Harris, Craig Comiter, and Christopher Elliott Andrew Sun*Andrew Sun* More articles by this author , Catherine HarrisCatherine Harris More articles by this author , Craig ComiterCraig Comiter More articles by this author , and Christopher ElliottChristopher Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557454.61387.c7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is a standard therapy for refractory overactive bladder (OAB). Traditionally, SNM placement involves placement of an S3 lead with 1-3 weeks of testing before considering a permanent implant. Given the potential risk of bacterial contamination during testing and high success rates published by some experts, we compared the costs of traditional 2-stage against single-stage SNM placement for OAB. METHODS: We performed a cost minimization analysis using published data on 2-stage SNM success rates, SNM infection rates, and direct reimbursements from Medicare for 2017 (Figure 1). We compared the costs associated with a 2-stage versus single-stage approach. We performed sensitivity analyses of the primary variables to assess where threshold values occurred and used separate models for freestanding ambulatory surgery centers (ASC) and outpatient hospital departments (OHD). RESULTS: Based on published literature, our base case assumed a 69% SNM success rate, a 5% 2-stage approach infection rate, a 1.7% single-stage approach infection rate, and removal of 50% of non-working single-stage SNMs. In both ASC ($17,613 vs $18,194) and OHD ($19,832 vs $21,181) settings, single-stage SNM placement was less costly than 2-stage placement. The minimum SNM success rates to achieve savings with a single-stage approach occur at 65.4% and 61.3% for ASC and OHD, respectively (Figure 2). CONCLUSIONS: Using Medicare reimbursement, single-stage SNM placement is likely to be less costly than 2-stage placement for most practitioners. The savings are tied to SNM success rates and reimbursement rates, with the success in centers of excellence (∼90%) saving up to $5014 per case. Source of Funding: None Stanford, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1187-e1187 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Sun* More articles by this author Catherine Harris More articles by this author Craig Comiter More articles by this author Christopher Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...