ONLINE MARKETING PATTERNS OF VASECTOMY REVERSAL PRACTICES.

Vasectomy reversal (VR) is rarely covered by insurance, and is associated with high direct and indirect costs to the patient. We sought to determine the ease with which patients can compare the characteristics of various academic and private VR practices, using an online search engine. Additionally, we sought to determine differences in VR practice patterns between academic and private practices. We identified VR practices operating within the top 50 populous metropolitan areas in the USA. Practice websites were reviewed to obtain information such as educational background of providers, use of operating microscope, ability to perform vasoepididymostomy (VE), surgical volume, and out-of-pocket cost. Based on the information available from practice websites, providers were assigned a non-validated “REVERSAL score” out of 12, based on 8 domains (Risks disclosure; provider’s Educational background; ability to perform VE; Expense disclosure; success Rate disclosure; Surgical volume disclosure; disclosure of Alternatives to VR; and Level of magnification used for VR). Descriptive statistics were used to compare the results between academic and private practices. 107 providers were identified (29 academic and 78 private). All but 2 were male, and similarly all but 2 had Doctor of Medicine (M.D.) degrees. Review of practice websites allowed us to obtain complete information (REVERSAL score of 12) on only one provider (academic), with the majority (66%) of providers achieving REVERSAL score of ≤6. Providers with formal fellowship training in andrology, microsurgery, and/or infertility achieved higher REVERSAL scores compared to those without (6.9 ± 2.4 vs. 4.8 ± 2.4, p < 0.01). Academic providers were more likely to have completed pertinent fellowship training compared to private practice providers (97% vs. 44%, p < 0.05). Only 14% of academic providers disclosed procedure cost online, compared to 40% of private practice providers (p < 0.05). There was a trend toward increased use of online advertisements by private practice providers (22% vs. 10%, p = 0.07), and increased reference to literature success rates by academic providers (59% vs. 41%, p = 0.10). Among the 35 providers who disclosed pricing online, mean cost of VR was $5990 ± 1935. There was a non-significant trend toward increased cost with academic practices compared to private practices ($7337 ± 1103 vs. $5765 ± 1964, p = 0.09). There was significant reduction in cost when comparing non-urologists vs. urologists ($3584 ± 1554 vs. $6591 ± 1518, p < 0.01), and when comparing providers without pertinent fellowship training to those with ($5405 ± 2000 vs. $6769 ± 1590, p < 0.05). There is significant lack of transparency in publicly available information from VR practices, both academic and private. Practices should implement measures to improve the dissemination of information to the general public, so that patients may more easily compare various providers.