Cost benefit micro-analysis of performing urine cultures as a mean to reduce post-flexible cystoscopy urosepsis: a comparative study between two centres.

Abstract

Background: In Australia, flexible cystoscopy is a key diagnostic tool in urology, employed to manage various conditions. However, it carries risks like urinary tract infections and urosepsis, which lead to significant healthcare expenses. This study evaluates the cost-effectiveness of pre-procedure urine cultures to prevent post-cystoscopy urosepsis.

Methods: A retrospective analysis of data from regional Toowoomba Base Hospital and metropolitan Gold Coast University Hospital was conducted to assess the efficacy of urine cultures in reducing urosepsis following flexible cystoscopy. The study reviewed patient records, analysing both the incidence of post-procedure urosepsis and the associated economic impact.

Results: The incidence of post-procedure urosepsis was found to be exceptionally low at 0.03%. Comparative analysis showed no significant reduction in urosepsis rates with the use of pre-procedure urine cultures (P=0.93). The financial analysis highlighted that the regional centre, which conducted urine cultures, incurred costs $ 26.14 per patient greater compared to the metropolitan centre that did not perform these cultures.

Conclusions: The study indicates that the low incidence of urosepsis does not justify the routine use of pre-operative urine cultures, given the substantial costs involved. These findings support current guidelines that do not recommend routine pre-procedure cultures for cystoscopy due to lack of evidence of benefit.