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OBJECTIVE Quantify incremental employee medical, pharmacy, sick leave, short- and long-term disability, and workers' compensation costs, absence days, and turnover associated with urge urinary incontinence (UUI) in employees. METHODS This retrospective 2001-2011 database comparison of employees with UUI versus those without UUI (controls) included employees aged 18.5 to 64.0 years at index, with 6-month preindex and 12-month postindex health plan enrollment. Logistic and generalized linear models measured postindex costs, absences, and turnover. RESULTS The study included 1448 employees with UUI and 337,796 controls. Employees with UUI had statistically significantly higher medical (131% higher), pharmacy (52%), sick leave (30%), and short-term disability (74%) costs and more sick leave (22%) and short-term disability (99%) days than controls (all P < 0.02). CONCLUSIONS Employees with UUI had 117% greater medical and pharmacy costs, 47% greater total absence costs, and 63% more absence days than employees without UUI.

Receiver-operating characteristic (ROC) analysis was originally developed during World War II to analyze classification accuracy in differentiating signal from noise in radar detection.1 Recently, the methodology has been adapted to several clinical areas heavily dependent on screening and diagnostic tests,2–4 in particular, laboratory testing,5 epidemiology,6 radiology,7–9 and bioinformatics.10 ROC analysis is a useful tool for evaluating the performance of diagnostic tests and more generally for evaluating the accuracy of a statistical model (eg, logistic regression, linear discriminant analysis) that classifies subjects into 1 of 2 categories, diseased or nondiseased. Its function as a simple graphical tool for displaying the accuracy of a medical diagnostic test is one of the most well-known applications of ROC curve analysis. In Circulation from January 1, 1995, through December 5, 2005, 309 articles were published with the key phrase “receiver operating characteristic.” In cardiology, diagnostic testing plays a fundamental role in clinical practice (eg, serum markers of myocardial necrosis, cardiac imaging tests). Predictive modeling to estimate expected outcomes such as mortality or adverse cardiac events based on patient risk characteristics also is common in cardiovascular research. ROC analysis is a useful tool in both of these situations. In this article, we begin by reviewing the measures of accuracy—sensitivity, specificity, and area under the curve (AUC)—that use the ROC curve. We also illustrate how these measures can be applied using the evaluation of a hypothetical new diagnostic test as an example. A diagnostic classification test typically yields binary, ordinal, or continuous outcomes. The simplest type, binary outcomes, arises from a screening test indicating whether the patient is nondiseased (Dx=0) or diseased (Dx=1). The screening test indicates whether the patient is likely to be diseased or not. When >2 categories are used, the test data can be on an ordinal rating …

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms associated with BPH are highly prevalent among aging men and place a large socioeconomic burden on the US health care system. Few nationally representative datasets are available that have evaluated patterns of non-surgical care for men with BPH. To examine national practice patterns for incident BPH in men age 18þ, stratified by age 30 days apart, based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 600.x (BPH), 596.0 (bladder neck obstruction), 788.20 (urinary retention), and 788.21 (incomplete bladder emptying), were included between 7/1/2009 and 6/30/2012. Other inclusion criteria for incident BPH (vs prevalent disease) were continuous enrollment for 1 year before and 6 months after the first diagnosis date, and no BPH diagnosis during the previous year. Pts with ICD-9 diagnoses of neurologic conditions or urologic malignancy were excluded. Overall outcomes through 9/30/2013 were analyzed. Variables of interest included pt comorbidities, demographics, diagnostic tests, and medication prescriptions. RESULTS: A total of 38,252 men were included. The majority (24,814, 65%) were aged 65þ, and 41% had 1þ comorbid conditions. Diagnostic tests included post-void residual measurement in 21%, renal ultrasound in 9%, cystoscopy in 6%, prostate ultrasound in 3%, and urodynamics in 1% of pts. A total of 58% of men were prescribed BPH medications, including alpha blockers (50%) and/or 5-alpha reductase inhibitors (24%). Older men had higher rates of prescriptions for both alpha blockers and 5-alpha reductase inhibitors than younger men (Table 1). CONCLUSIONS: Men aged 65þ had higher rates of prescriptions overall, possibly due to more severe symptoms among older men. The relatively low rate of renal ultrasound and other diagnostic tests may reflect adherence to the 2010 American Urological Association BPH guidelines. Source of Funding: No financial support was received for this study.

We determine the most common etiology of spontaneous perirenal hemorrhage.A MEDLINE search of the English language literature from 1985 to 1999 revealed 47 publications and 165 cases of spontaneous renal hemorrhage meeting our study entry criteria. These criteria were presentation of raw data including imaging modality, pathological confirmation (123 cases) or long-term (greater than 2 years) (42) imaging and/or clinical followup and no history of recent trauma, anticoagulant use, dialysis or renal transplant. Meta-analysis was performed using analysis of counts derived from contingency tables and pooled and stratified analysis.Hemorrhage was identified by ultrasound in 56 of 100 cases (56%) and by computerized tomography (CT) in all 135 cases assessed (100%). Etiology was correctly identified with an overall sensitivity and specificity of 0.11 and 0.33 for ultrasound and 0.57 and 0.82 for CT. Angiography in 81 cases revealed active bleeding in 11. The most common etiology of spontaneous renal hemorrhage was benign or malignant neoplasm (101 cases, 61%) with angiomyolipoma being predominant (48) followed closely by renal cell carcinoma (43). Vascular disease was the next most common offender (28 cases, 17%) with polyarteritis nodosa occurring most frequently (20).The most common cause of spontaneous perirenal hemorrhage is renal neoplasm and approximately 50% of such neoplasms are malignant. CT is the method of choice for evaluation of perirenal hemorrhage, although its sensitivity for detection of underlying etiology is only moderate.

We determine the value of color mapping of bladder wall thickness for detection of tumor as a component of virtual cystoscopy.A total of 31 subjects with hematuria and/or a history of bladder tumor underwent helical computerized tomography of the pelvis after distention of the bladder with air. Three-dimensional (D) models were constructed, and thickness of the wall was color mapped according to a fixed and validated mm. scale. Axial source images and 3-D models were reviewed and graded for the presence of wall thickening. A comparison was made with findings on conventional cystoscopy in 31 patients and pathological specimen in 13.Compared with conventional cystoscopy, the analysis of axial image yielded a sensitivity of 0.80, specificity 0.90, positive predictive value 0.80 and negative predictive value 0.90 for the presence of tumor. Examination of color mapped 3-D renderings resulted in 0.83, 0.36, 0.42 and 0.71, respectively.Thin axial computerized tomography of the air distended bladder shows promise as a potential screening tool for bladder cancer. The low specificity of color mapped 3-D renderings makes the technique inappropriate for screening. It may valuable for guiding urologists to additional suspicious sites in a patient with a known tumor.

Background —The recently reported Multicenter Automatic Defibrillator Implantation Trial (MADIT) showed improved survival in selected asymptomatic patients with coronary disease and nonsustained ventricular tachycardia. The economic consequences of defibrillator management in this patient population are unknown. Methods and Results —Patients were followed up to quantify their use of healthcare services, including hospitalizations, physician visits, medications, laboratory tests, and procedures, during the trial. The costs of these services, including the costs of the defibrillator, were determined in patients randomized to defibrillator and nondefibrillator therapy. Incremental cost-effectiveness ratios were calculated by relating these costs to the increased survival associated with the use of the defibrillator. The average survival for the defibrillator group over a 4-year period was 3.66 years compared with 2.80 years for conventionally treated patients. Accumulated net costs were $97 560 for the defibrillator group compared with $75 980 for individuals treated with medications alone. The resulting incremental cost-effectiveness ratio of $27 000 per life-year saved compares favorably with other cardiac interventions. Sensitivity analyses showed that the incremental cost-effectiveness ratio would be reduced to ≈$23 000 per life-year saved if transvenous defibrillators were used instead of the older devices, which required thoracic surgery for implantation. Conclusions —An implanted cardiac defibrillator is cost-effective in selected individuals at high risk for ventricular arrhythmias.