Cost analysis of different forms of bladder catheterization after pelvic organ prolapse surgery

Objectives Approximately 15 to 45 percent of female patients develop acute transient urinary retention following pelvic organ prolapse surgery. Catheter options for bladder drainage in this setting include transurethral indwelling catheter (TIC), suprapubic tube (SPT) and intermittent self-catheterization (ISC). Although each strategy has associated risks and benefits, no one strategy has been shown universally superior over the others. We aim to evaluate the cost of these different bladder catheterization strategies. Methods A health system perspective was taken and a decision tree model was constructed to evaluate the costs associated with each catheterization strategy over a 6 week horizon. Base-cases were set based on recently published clinical data of our institutions, two tertiary care centers, and in systematic reviews. All costs associated were established in consultation with process stakeholders, in addition to published values. Results Preliminary analysis demonstrated the average cost at ourprimary site of TIC to be 117.04CAD per patient (range: 21.08-407.23 CAD), which was less than the average cost of SPT and ISC, 286.18CAD per patient (range: 157.83-673.34CAD), and 184.16CAD per patient (range: 129.03-295.12CAD), respectively. Although overall costs were higher at our secondary site, TIC was still less expensive than SPT, averaging 68.41CAD per patient (range 27.16-299.07CAD) and 271.39 (189.69-536.13CAD), respectively. Conclusions Given these results, we continue our analyses in the context of published risk and benefit profiles of different post-operative catheterization strategies and associated preference data in an effort to further establish the cost benefit of these catheter options.