{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:12:16Z","timestamp":1793146336790,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>The American Urological Association (AUA) guidelines recommend evaluating asymptomatic microhematuria (MH) at \u2265\u20093 red blood cells per high powered field (RBCs\/hpf), resulting in significant costs with limited bladder cancer detections. This study evaluates alternative diagnostic strategies to improve the cost\u2010effectiveness of asymptomatic MH evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The cost\u2010effectiveness analysis compared three alternative strategies: Strategy 1 (cystoscopy at \u2265\u200926 RBCs\/hpf) was compared to a 3 RBCs\/hpf threshold, while Strategy 2 (cystoscopy and renal ultrasound at \u2265\u20093 RBCs\/hpf) and Strategy 3 (cystoscopy and renal ultrasound at \u2265\u200926 RBCs\/hpf) were compared to the AUA guidelines. Total costs, cost per patient evaluated, costs per cancer detected, and incremental cost\u2010effectiveness ratios (ICERs) were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Strategy 3 minimized costs without significantly reducing early cancer detection rates. It was cost\u2010effective for females (ICER\u2009=\u2009$120,649) and the total sample (ICER\u2009=\u2009$50,648) but not specifically for males (ICER\u2009=\u2009$23,326). Strategies 1 and 2 yielded lower cost savings and were less efficient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Strategy 3\u2014performing cystoscopy and renal ultrasound for higher\u2010risk patients (\u2009\u2265\u200926 RBCs\/hpf)\u2014offers a more cost\u2010effective approach than the AUA guidelines, particularly for women. Future studies should incorporate additional patient variables and diagnostic test characteristics.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.28148","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T09:35:08Z","timestamp":1747128908000},"page":"1661-1669","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating Cost\u2010Effective Strategies for Asymptomatic Microhematuria Diagnosis: A Risk\u2010Based Alternative to the American Urological Association Guidelines"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4754-8759","authenticated-orcid":false,"given":"Krishay","family":"Sridalla","sequence":"first","affiliation":[{"name":"Department of Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4028-010X","authenticated-orcid":false,"given":"Hiten D.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Urology Northwestern University Feinberg School of Medicine Chicago Illinois USA"},{"name":"Department of Surgery Jesse Brown Veterans Administration Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin D.","family":"French","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Northwestern University Feinberg School of Medicine Chicago Illinois USA"},{"name":"Department of Veterans Affairs Center of Innovation for Complex Chronic Healthcare Hines Illinois USA"},{"name":"Department of Medical Social Science Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua J.","family":"Meeks","sequence":"additional","affiliation":[{"name":"Department of Urology Northwestern University Feinberg School of Medicine Chicago Illinois USA"},{"name":"Department of Surgery Jesse Brown Veterans Administration Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine (Biostatistics Division) Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuying","family":"Xing","sequence":"additional","affiliation":[{"name":"Corewell Health Research Institute Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Bentrem","sequence":"additional","affiliation":[{"name":"Department of Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA"},{"name":"Department of Surgery Jesse Brown Veterans Administration Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.17598"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.3800"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0090-4295(99)80006-5"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.06.045"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-5394.2002.106011.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.2280"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000001297"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2017.07.016"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2023.08.002"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2010.12.093"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1142"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/10590501.2013.844755"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2018.04.065"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.0739"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2321030222"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2016.06.009"},{"key":"e_1_2_8_18_1","unstructured":"Corporation M Excel (Microsoft 365 Subscription) Microsoft Corporation 2025."},{"key":"e_1_2_8_19_1","unstructured":"Services CfMM Physician Fee Schedule Search Baltimore: Centers for Medicare & Medicaid Services November 21 2024 https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search."},{"key":"e_1_2_8_20_1","unstructured":"Services CfMM.Hospital Outpatient Prospective Payment System (OPPS) Baltimore: Centers for Medicare & Medicaid Services; 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