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Utility scores for vesicoureteral reflux and anti-reflux surgery
Caleb Nelson, MD, MPH1, Jonathan C. Routh, MD, MPH2, Tanya Logvinenko, PhD1, Ilina Rosoklija, MPH1, Paul Kokorowski, MD, MPH3.
1Boston Children's Hospital, Boston, MA, USA, 2Duke University Medical Center, Durham, NC, USA, 3University of Southern California, LA, CA, USA.

BACKGROUND: Cost-utility analyses are often used to study conditions for which the optimal management strategy is controversial or ill-defined, such as vesicoureteral reflux (VUR). One requirement of such analyses is that utility score for the condition must be estimated; a “utility” is a value between 0 (death) and 1 (perfect health) that corresponds to the quality of life associated with the health state. We sought to measure utility scores for VUR and anti-reflux surgery using a large nationally-representative survey.
METHODS: A cross-sectional survey was administered to a well-characterized national demographically-representative panel of adults; only respondents who had ever been parents were included. The time trade-off (TTO) method was used. Each respondent saw one of four annualized VUR health states descriptions; these descriptions differed by including or omitting treatment with continuous antibiotic prophylaxis (CAP), and by including or omitting occurrence of febrile urinary tract infection (UTI). A 6 week post-operative health state following open ureteral reimplantation was also assessed.
RESULTS: 1200 individuals completed the survey (50% completion rate). Data were weighted to adjust for demographic differences between responders and non-responders. Mean age was 52 ± 15 years, 44% were male, and 68% were white. 29% had a college degree or higher. The mean utility score for VUR overall was 0.82 ± 0.28. Scores did not differ significantly among four VUR health states (with CAP/with UTI: 0.84± 0.26; with CAP/without UTI: 0.79± 0.30; without CAP/with UTI: 0.82± 0.28; without CAP/without UTI: 0.81± 0.27, p=0.2090). In multivariable model, higher score for the VUR health state was associated with female gender (p=0.0078), living in a single family house (p=0.0330), “other” race/ethnicity (not White, Black or Hispanic), and having at least one child between 0-12 years living at home (p=0.0313). The 6-week post-operative period garnered a utility of 0.71 ± 0.43.
CONCLUSIONS: From a community perspective, VUR is perceived as having a substantial impact on health-related quality of life, with scores comparable to reported values for uncorrected strabismus (0.8), insulin dependent diabetes (0.84), and chronic hepatitis B (0.81). Use of CAP and occurrence of UTI do not seem to impact community perspective on HRQOL associated with living with VUR.

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