TY  - BOOK
AU  - Dieter, Alexis A
TI  - Cost-effectiveness of agents used for evaluation of ureteral patency during intraoperative cystoscopy in gynecologic and urogynecologic surgery
SN  - 0002-9378
PY  - 2022///
KW  - *Coloring Agents/ad [Administration & Dosage]
KW  - *Cystoscopy
KW  - *Gynecologic Surgical Procedures
KW  - *Ureteral Obstruction/di [Diagnosis]
KW  - Coloring Agents/ec [Economics]
KW  - Cost-Benefit Analysis
KW  - Female
KW  - Fluorescein/ad [Administration & Dosage]
KW  - Fluorescein/ec [Economics]
KW  - Humans
KW  - Indigo Carmine/ad [Administration & Dosage]
KW  - Indigo Carmine/ec [Economics]
KW  - Intraoperative Complications/di [Diagnosis]
KW  - North Carolina
KW  - Phenazopyridine/ad [Administration & Dosage]
KW  - Phenazopyridine/ec [Economics]
KW  - MedStar Washington Hospital Center
KW  - Obstetrics and Gynecology
KW  - Journal Article
N2  - BACKGROUND: Intraoperative evaluation of ureteral patency is often performed in gynecologic and urogynecologic surgery. Many agents are used to help assess the patency, each with its own associated cost, ease of use, and adverse reactions. Some agents, such as dextrose, are used as an instillation fluid to create a viscosity difference and aid the visualization of a ureteral jet. Others, such as oral phenazopyridine or the intravenous use of sodium fluorescein and indigo carmine, cause a color change of the urine to directly aid the visualization of ureteral jets. Recently, numerous studies have examined the efficacy and surgeon satisfaction of these agents. The studies have also emphasized certain options as associated with a lower cost. However, there have not been any cost studies comparing these agents; CONCLUSION: Our model suggests that oral phenazopyridine and dextrose instillation are the least expensive and the most effective agents to aid in the visualization of ureteral patency during intraoperative cystoscopy, although dextrose is associated with higher costs owing to a higher rate of adverse reactions (primarily urinary tract infections). Intravenous sodium fluorescein and indigo carmine are historically popular first-choice agents. However, they were found to be more expensive and less effective as primary agents in our model and should likely be reserved for use as secondary agents in the event that the visualization of ureteral jets is unclear with the initial use of phenazopyridine or dextrose. Copyright (c) 2021 Elsevier Inc. All rights reserved; OBJECTIVE: To compare the cost-effectiveness of the following 4 agents that are commonly used in assessing ureteral patency intraoperatively: oral phenazopyridine, dextrose instillation, intravenous sodium fluorescein, and intravenous indigo carmine; RESULTS: Oral phenazopyridine, followed by an intravenous agent if needed, had a mean cost of; STUDY DESIGN: We constructed a decision-analytic model to compare cystoscopy using oral phenazopyridine, dextrose instillation, intravenous sodium fluorescein, and intravenous indigo carmine. Failure to see efflux resulted in work-ups for ureteral obstruction. The probabilities were obtained from published studies, and the probability of successfully seeing efflux ranged from 0.92 with oral phenazopyridine to 0.99 with intravenous indigo carmine. The costs of the agents, adverse effects, and ureteral obstruction work-ups were obtained from the University of North Carolina at Chapel Hill Department of Pharmacy, the Healthcare Cost and Utilization Project 2016 database and the FAIR Health Consumer database. The cost of a ureteral obstruction work-up used in our model ranged from
UR  - https://dx.doi.org/10.1016/j.ajog.2021.08.055
ER  -