LAUSR

BACKGROUND Several studies have compared short term catheterization approaches and have demonstrated no difference in patient satisfaction, but none have evaluated their costs. OBJECTIVE To evaluate the costs of three pathways for short term catheter management in patients diagnosed with urinary retention following pelvic surgery. METHODS We utilized a Markov decision tree to model costs from the society's perspective. In Pathway 1: patients have an indwelling catheter and return to the office for voiding trial. Pathway 2: patients have an indwelling catheter and discontinue the catheters at home. Pathway 3: patients are taught clean intermittent catheterization (CIC) postoperatively. We accounted for office visits, emergency room visits, urinary tract infection testing and treatment, transportation, caregiver time, teaching time, and supplies. RESULTS CIC is the least costly at $79 per patient, followed by self-removal of catheter ($128), and then office voiding trial ($185). One-way sensitivity analyses showed that distance between patient and office and rates of spontaneous voiding following catherization had the greatest impact. When patients need to travel more than 5 miles to the office for catheter removal, self-removal of catheter is less costly than office voiding trial. CIC is most cost-saving only if the patients are taught CIC postoperatively, once it has been determined that they have urinary retention and require catheterization. If all patients were to be taught CIC routinely before surgery, CIC becomes the most costly option. Based on annual surgical volume, if even $30 were saved per patient with postoperative urinary retention, the estimated total societal savings would be $420,000 to $7.2 million. CONCLUSIONS CIC as initial management of urinary retention following pelvic surgery is the most cost-saving when it is only taught postoperatively to patients after determining the need for catheterization. When this is not possible, self-removal of indwelling catheter is the most cost-saving option, especially as the distance between the patient and the provider increases. Choosing the optimal management guided by patient and provider factors can lead to significant cost savings annually in the United States.