Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).

<h4>Objective</h4>To determine the cost-effectiveness of in-utero percutaneous Vesico Amniotic Shunt (VAS) in the management of fetal lower urinary tract obstruction (LUTO).<h4>Design</h4>Model based economic analysis using data from the randomised controlled arm of the PLUTO...

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Autores principales:	Lavanya Diwakar, Rachel K Morris, Pelham Barton, Lee J Middleton, Mark D Kilby, Tracy E Roberts
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/24a1f75b0c6a4252804ed4c021b2f98e
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spelling	oai:doaj.org-article:24a1f75b0c6a4252804ed4c021b2f98e2021-11-18T08:41:00ZEvaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).1932-620310.1371/journal.pone.0082564https://doaj.org/article/24a1f75b0c6a4252804ed4c021b2f98e2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24376546/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>To determine the cost-effectiveness of in-utero percutaneous Vesico Amniotic Shunt (VAS) in the management of fetal lower urinary tract obstruction (LUTO).<h4>Design</h4>Model based economic analysis using data from the randomised controlled arm of the PLUTO (percutaneous vesico-amniotic shunting for lower urinary tract obstruction) trial.<h4>Setting</h4>Fetal medicine departments in United Kingdom, Ireland and Netherlands.<h4>Population or sample</h4>Pregnant women with a male, singleton fetus with LUTO.<h4>Methods</h4>Costs and outcomes were prospectively collected in the trial; three separate base case analyses were performed using the intention to treat (ITT), per protocol and uniform prior methods. Deterministic and probabilistic sensitivity analyses were performed to explore data uncertainty.<h4>Main outcome measures</h4>Survival at 28 days, 1 year and disease free survival at 1 year.<h4>Results</h4>VAS was more expensive but appeared to result in higher rates of survival compared with conservative management in patients with LUTO. Using ITT analysis the incremental cost effectiveness ratios based on outcomes of survival at 28 days, 1 year, or 1 morbidity-free year on the VAS arm were £ 15,506, £ 15,545, and £ 43,932, respectively.<h4>Conclusions</h4>VAS is a more expensive option compared to the conservative approach in the management of individuals with LUTO. Data from the RCT suggest that VAS improves neonatal survival but does not result in significant improvements in morbidity. Our analysis concludes that VAS is not likely to be cost effective in the management of these patients given the NICE (National Institute of Health and Clinical Excellence) cost threshold of £ 20,000 per QALY.Lavanya DiwakarRachel K MorrisPelham BartonLee J MiddletonMark D KilbyTracy E RobertsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 12, p e82564 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Lavanya Diwakar Rachel K Morris Pelham Barton Lee J Middleton Mark D Kilby Tracy E Roberts Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).
description	<h4>Objective</h4>To determine the cost-effectiveness of in-utero percutaneous Vesico Amniotic Shunt (VAS) in the management of fetal lower urinary tract obstruction (LUTO).<h4>Design</h4>Model based economic analysis using data from the randomised controlled arm of the PLUTO (percutaneous vesico-amniotic shunting for lower urinary tract obstruction) trial.<h4>Setting</h4>Fetal medicine departments in United Kingdom, Ireland and Netherlands.<h4>Population or sample</h4>Pregnant women with a male, singleton fetus with LUTO.<h4>Methods</h4>Costs and outcomes were prospectively collected in the trial; three separate base case analyses were performed using the intention to treat (ITT), per protocol and uniform prior methods. Deterministic and probabilistic sensitivity analyses were performed to explore data uncertainty.<h4>Main outcome measures</h4>Survival at 28 days, 1 year and disease free survival at 1 year.<h4>Results</h4>VAS was more expensive but appeared to result in higher rates of survival compared with conservative management in patients with LUTO. Using ITT analysis the incremental cost effectiveness ratios based on outcomes of survival at 28 days, 1 year, or 1 morbidity-free year on the VAS arm were £ 15,506, £ 15,545, and £ 43,932, respectively.<h4>Conclusions</h4>VAS is a more expensive option compared to the conservative approach in the management of individuals with LUTO. Data from the RCT suggest that VAS improves neonatal survival but does not result in significant improvements in morbidity. Our analysis concludes that VAS is not likely to be cost effective in the management of these patients given the NICE (National Institute of Health and Clinical Excellence) cost threshold of £ 20,000 per QALY.
format	article
author	Lavanya Diwakar Rachel K Morris Pelham Barton Lee J Middleton Mark D Kilby Tracy E Roberts
author_facet	Lavanya Diwakar Rachel K Morris Pelham Barton Lee J Middleton Mark D Kilby Tracy E Roberts
author_sort	Lavanya Diwakar
title	Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).
title_short	Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).
title_full	Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).
title_fullStr	Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).
title_full_unstemmed	Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).
title_sort	evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the pluto trial).
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/24a1f75b0c6a4252804ed4c021b2f98e
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Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial).

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