Examining cost-effectiveness of initial diagnostic exams for microscopic hematuria

Routine urinalysis for screening of genitourinary cancer isn't recommended by any major health group but patients who undergo urinalysis for a variety of other reasons are often found to have microscopic hematuria, which prompts further evaluation. A new article published by JAMA Internal Medicine explores the cost-effectiveness of four initial diagnostic protocols for these patients.

Joshua A. Halpern, M.D., M.S., of Weill Cornell Medicine, New York, and his coauthors analyzed the cost-effectiveness of: computed tomography (CT) alone, cystoscopy (using a scope to examine the urinary tract) alone, CT and cystoscopy combined, and renal (kidney) ultrasound and cystoscopy combined.

The combination of cystoscopy and renal ultrasound was the most cost-effective with an incremental cost of $53,810 per cancer detected, according to the results.

"The use of ultrasound in lieu of CT as the first-line diagnostic strategy will reduce the cost, morbidity and national expenditures associated with evaluation of AMH [asymptomatic microscopic hematuria]. Clinicians and policy makers should consider changing future guidelines in accordance with this finding," the article concludes.