Most Cost-Effective Strategy (Theoretically) for Evaluating Asymptomatic Microscopic Hematuria

Asymptomatic microscopic hematuria (AMH; defined by red blood cells on urine microscopy, not dipstick testing) raises concerns about occult genitourinary cancer. In this decision analysis, investigators used standard research sources and evidence-based assumptions to assess the cost-effectiveness of detecting genitourinary cancer with each of four strategies:

• Combination computed tomography (CT) urography and cystoscopy

• Combination renal ultrasound and cystoscopy

• Cystoscopy alone

• CT urography alone

Neither ultrasound alone nor voided-urine cytology were evaluated, due to their relatively poor sensitivity.

Combination renal ultrasound and cystoscopy was the most cost-effective, with an incremental cost per cancer detected of about US$53,000. Subst…