Mitchell M Conover1, Michele Jonsson Funk, Alan C Kinlaw, AnnaMarie Connolly, Jennifer M Wu. 1. Department of Epidemiology, Gillings School of Global Public Health, the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, and the Center for Women's Health Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Abstract
OBJECTIVE: To estimate utilization rates for cystometrograms and describe trends in urodynamic procedures among U.S. women from 2000 to 2012. METHODS: We analyzed outpatient administrative health care claims for women aged 18 years or older from 2000 to 2012. The database contains deidentified and adjudicated claims from approximately 150 U.S. payers for employees, spouses, and retirees. We identified cystometrograms, which occur during bladder filling and represent a major component of complex urodynamics, and concurrent procedures; we also assessed age, year, region, health care provider specialty, and associated diagnosis codes. We estimated standardized cystometrogram utilization rates per 10,000 person-years and 95% confidence intervals (CIs) and used stratified Poisson models to estimate the independent (adjusted) effects of year and region. RESULTS: During 142,928,847 person-years of observation among 57,629,961 eligible women, we identified 561,823 cystometrograms for an overall utilization rate of 39.3 per 10,000 person-years (95% CI 39.2-39.4). Cystometrogram utilization increased with age with a peak at age 76 years (86.6/10,000 person-years, 95% CI 84.5-88.7). Standardized rates were relatively constant from 2000 to 2004 and then increased and peaked in 2009 (43.3/10,000 person-years, 95% CI 43.0-43.7). In 2012, they were substantially lower (27.6/10,000 person-years, 95% CI 27.4-27.9). CONCLUSION: Urodynamic procedures were more commonly performed in women aged 65 years or older. Utilization peaked in 2009 and declined sharply in 2012. Clinically, we need to assess the underlying reasons for these trends (ie, whether they reflect a decrease in urodynamics before stress urinary incontinence surgery) and whether these trends reflect appropriate use of this diagnostic study. LEVEL OF EVIDENCE: : II.
OBJECTIVE: To estimate utilization rates for cystometrograms and describe trends in urodynamic procedures among U.S. women from 2000 to 2012. METHODS: We analyzed outpatient administrative health care claims for women aged 18 years or older from 2000 to 2012. The database contains deidentified and adjudicated claims from approximately 150 U.S. payers for employees, spouses, and retirees. We identified cystometrograms, which occur during bladder filling and represent a major component of complex urodynamics, and concurrent procedures; we also assessed age, year, region, health care provider specialty, and associated diagnosis codes. We estimated standardized cystometrogram utilization rates per 10,000 person-years and 95% confidence intervals (CIs) and used stratified Poisson models to estimate the independent (adjusted) effects of year and region. RESULTS: During 142,928,847 person-years of observation among 57,629,961 eligible women, we identified 561,823 cystometrograms for an overall utilization rate of 39.3 per 10,000 person-years (95% CI 39.2-39.4). Cystometrogram utilization increased with age with a peak at age 76 years (86.6/10,000 person-years, 95% CI 84.5-88.7). Standardized rates were relatively constant from 2000 to 2004 and then increased and peaked in 2009 (43.3/10,000 person-years, 95% CI 43.0-43.7). In 2012, they were substantially lower (27.6/10,000 person-years, 95% CI 27.4-27.9). CONCLUSION: Urodynamic procedures were more commonly performed in women aged 65 years or older. Utilization peaked in 2009 and declined sharply in 2012. Clinically, we need to assess the underlying reasons for these trends (ie, whether they reflect a decrease in urodynamics before stress urinary incontinence surgery) and whether these trends reflect appropriate use of this diagnostic study. LEVEL OF EVIDENCE: : II.