Evaluating Cost-Effective Strategies for Asymptomatic Microhematuria Diagnosis: A Risk-Based Alternative to the American Urological Association Guidelines.
Document Type
Article
Publication Date
5-13-2025
Publication Title
Journal of surgical oncology
Abstract
BACKGROUND AND OBJECTIVES: The American Urological Association (AUA) guidelines recommend evaluating asymptomatic microhematuria (MH) at ≥ 3 red blood cells per high powered field (RBCs/hpf), resulting in significant costs with limited bladder cancer detections. This study evaluates alternative diagnostic strategies to improve the cost-effectiveness of asymptomatic MH evaluation.
METHODS: The cost-effectiveness analysis compared three alternative strategies: Strategy 1 (cystoscopy at ≥ 26 RBCs/hpf) was compared to a 3 RBCs/hpf threshold, while Strategy 2 (cystoscopy and renal ultrasound at ≥ 3 RBCs/hpf) and Strategy 3 (cystoscopy and renal ultrasound at ≥ 26 RBCs/hpf) were compared to the AUA guidelines. Total costs, cost per patient evaluated, costs per cancer detected, and incremental cost-effectiveness ratios (ICERs) were calculated.
RESULTS: Strategy 3 minimized costs without significantly reducing early cancer detection rates. It was cost-effective for females (ICER = $120,649) and the total sample (ICER = $50,648) but not specifically for males (ICER = $23,326). Strategies 1 and 2 yielded lower cost savings and were less efficient.
CONCLUSIONS: Strategy 3-performing cystoscopy and renal ultrasound for higher-risk patients ( ≥ 26 RBCs/hpf)-offers a more cost-effective approach than the AUA guidelines, particularly for women. Future studies should incorporate additional patient variables and diagnostic test characteristics.
Recommended Citation
Sridalla K, Patel HD, French DD, Meeks JJ, Zhao L, Xing Y et al evaluating cost-effective strategies for asymptomatic microhematuria diagnosis: a risk-based alternative to the American Urological Association Guidelines. J Surg Oncol. 2025 May 13. doi: 10.1002/jso.28148. Epub ahead of print. PMID: 40358418.
DOI
10.1002/jso.28148
ISSN
1096-9098
PubMed ID
40358418
