The Value Of Newborn Urinary Proteome Analysis In The Evaluation And Management Of Ureteropelvic Junction Obstruction: A Cost-Effectiveness Study

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 02 Feb 2009 - 4:00 PDT

email to a friend   printer friendly   opinions  

UroToday.com - Proteomic technologies are emerging as a sensitive, fast, and readily available tool for analysis of protein patterns in different body fluids, especially urine. Compared to the conventional process of marker definition, this approach allows inclusion of large numbers of proteins in order to identify diagnostically useful protein patterns. In a recent journal article, Dr. Hrair-George Mesrobian evaluated the usefulness of urinary proteome in regards to evaluation and management of ureteropelvic junction obstruction.

He utilized a Markov model created to compare watchful waiting with one incorporating a urinary proteome analysis at birth as a marker of disease progression. The cost analysis included surgery, imagining, and office visits based on current hospital charge data. The study analyzed a total of 53 different variables.

On average, the incorporation of this marker of progression results in an incremental C-E gain of $8,000 per quality adjusted life year (QALY) per patient compared to watchful waiting. The results are not sensitive to variation of any of the probabilities including costs and quality of life parameters used for the base-case analysis.

Dr. Mesrobian concluded that the incorporation of urinary proteome analysis in the initial evaluation of UPJO significantly reduces costs and increases the QALYs. The test increases the odds of detecting UPJO progression from 1:3 to 1:1, while improving the overall C-E. Additionally, he concludes that his findings justify continued research in this area. It would be quite useful to have a noninvasive test, such as urinary proteomic, to help delineate which of these patients are actually the ones we worry about progressing to complete obstruction necessitating surgery. We can potentially save many of these children invasive studies, such as MAG-3 renal scans, VCUG's, and MR urography, based on a simple urinary collection.

Mesrobian HG
World J Urol. 2008 Nov 26. Epub ahead of print.
doi:10.1007/s00345-008-0355-z

Written by UroToday.com Medical Editor Pasquale Casale, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2008 - UroToday

• Additional
• References
• Citations