Annual screening for malignancy among children with spina bifida with cystoplasty unlikely to be cost effective
Research Activities, May 2012, No. 381
Screening programs for disease are frequently subject to cost-effectiveness analysis. Screening for malignancy following bladder augmentation among children with spina bifida (also known as "augmentation cystoplasty") is a case in point.
In order to determine the potential for screening cystoscopy and cytology to be cost effective, a research team from Children's Hospital in Boston used formal decision analysis techniques. Their analysis suggested that screening for malignancy in patients with spina bifida after cystoplasty with annual cystoscopy and cytology is highly unlikely to be cost effective at accepted willingness to pay thresholds. In a hypothetical group, the individual increase in life expectancy for the entire group was 2.3 months with an average lifetime cost of $55,200 per capita. The discounted incremental cost-effectiveness ratio was $273,718, which exceeds the $100,000 per life year gained threshold considered to be cost effective for medical interventions.
Neurogenic bladder dysfunction is common in children with spina bifida and is most often treated by bladder augmentation. This procedure appears to pose an increased risk of malignancy, but performing a controlled trial to learn more about this outcome is impractical due to the low incidence of malignancy and long interval from cystoplasty to tumor development. This study was supported in part by the Agency for Healthcare Research and Quality (T32 HS000063).
See "Screening for malignancy after augmentation cystoplasty in children with spina bifida: A decision analysis" by Paul J. Kokorowski, M.D., Jonathan C. Routh, M.D., Joseph G. Borer, M.D., and others in the October 2011 Journal of Urology 186, pp. 1437-1443.