We began with the construction of a decision tree model with three different postoperative catheter management strategies: patients who have an indwelling catheter and return to the office for voiding trial; patients who have an indwelling catheter and discontinue the catheters at home; and patients who are taught clean intermittent self-catheterization. We obtained the probabilities, costs, and utilities associated with each step of the decision tree model from the published literature.
We concluded that clean intermittent catheterization is the most cost-saving when it is possible to teach patients how to self-catheterize after they are diagnosed with postoperative urinary retention. This approach is not always feasible or practical as the patients would have to be taught clean intermittent self-catheterization during their admission, postoperatively. Therefore, when this is not possible, instructing every patient pre-operatively how to self-catheterize is no longer cost-saving. Instead, in that setting, self-removal of indwelling catheter is the most cost-saving option, especially as the distance that patients would have to travel to the providers’ office increases.
Our study showed that choosing the optimal management can lead to significant cost savings – for example, if even $30 were saved per patient with postoperative urinary retention, the estimated total societal savings in the U.S. would be $420,000 to $7.2 million.
Written by: Rui Wang, MD, Elena Tunitsky-Bitton, MD, Department of Obstetrics and Gynecology, Division of Urogynecology, Hartford Hospital, Hartford, CT, USA
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