Research News

Hospitalizations for VUR Have Decreased but Costs Have Risen

Fewer children are being hospitalized for the urogenital condition, vesicoureteral reflux, and those who are hospitalized stay fewer days, yet condition-related costs have nearly doubled.  These are the findings from a Nationwide Children’s study appearing in Pediatric Nephrology.     

Vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder into the ureter.  “Although it is the most common congenital abnormality of the urinary tract in children, little is known about its impact on inpatient healthcare utilization in the United States,” said David Hains, MD, principal investigator in the Center for Clinical and Translational Research at The Research Institute at Nationwide Children’s.

To shed light on the socioeconomic burden of VUR, Nationwide Children’s investigators examined the demographics of children admitted to the hospital with the primary discharge diagnosis of VUR between 2000 and 2006. They used data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database in 2000, 2003 and 2006, which was designed to identify and track trends in hospital utilization, access, cost and outcome across the United States.

Their findings showed that although the number and mean lengths of hospitalization decreased during the study period, mean hospital charges per day increased by 93 percent.  

“The socioeconomic burden of VUR is large and increasing at a rapid rate in the United States,” said John David Spencer, MD, Nephrology fellow at Nationwide Children’s and lead study author. “The data suggests that the increase in aggregate national charges for inpatient VUR management is primarily a reflection of increased surgical charges.”

Drs. Hains and Spencer say more efforts are needed to evaluate cost-effective strategies for the evaluation and management of VUR.  The study suggests the following areas of future research that will yield potential improvements in care:

  • Evaluating for VUR in selected patient populations
  • Preventing breakthrough urinary tract infections and renal scarringMinimizing the use of prophylactic antibiotics
  • Reserving surgical intervention for children with high-grade VUR or recurrent urinary tract infections

“At Nationwide Children’s, our group is involved in addressing many of these areas of need with our ongoing research projects,” he said.  “In conjunction with Dr. Andrew Schwaderer, our laboratory is analyzing genetic issues that may complicate VUR.”

The study also showed that a subset of children with VUR, most commonly females and children 4 years old and younger, require inpatient management more than other groups. Those hospitalized with VUR often undergo ureteral reimplantation and often need management of related diagnoses.

Spencer JD, Schwaderer A, McHugh K, Vanderbrink B, Becknell B, Hains DS. The demographics and costs of inpatient vesicoureteral reflux management in the USA. Pediatr Nephrol. 2011 May 10. [Epub ahead of print]

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