Abstract：
In 2003, Florida Medicaid discontinued coverage of routine neonatal circumcision (NC) resulting in an increase in nonneonatal circumcisions. Florida Medicaid is one of 16 state healthcare plans that do not cover NC. Florida Medicaid covers male circumcision in a child ≥3 years for a defined medical indication or persistent phimosis refractory to topical steroid therapy (TST). We sought to assess the economic impact of the evaluation and management of phimosis/circumcision in Florida Medicaid males ≥3 years treated at Nemours Children\'s Hospital.
We performed an IRB approved retrospective chart review of all male Florida Medicaid patients ≥3 years seen at NCH for phimosis/circumcision from Sept. 2016-Sept. 2019. Data extracted included demographics, age at presentation, prior treatment with TST, response to TST, and surgical interventions. The patients were stratified into three management groups. Total costs for each group were based upon estimated Medicaid reimbursement rates. Data were analyzed using descriptive analysis on SPSS.
Seven hundred and sixty-three males were evaluated. Age at presentation ranged from 3 to 17 years and 59% of patients were 3-6 years at initial presentation. Three hundred and forty patients underwent circumcision. The total estimated cost of care for all patients was $1,345,533.90. This compares to an estimated cost of $171,675 if all individuals underwent NC at 2020 costs.
The total estimated cost associated with the evaluation and management of 763 patients ≥3 years for phimosis/circumcision was 7.8 times the estimated cost of NC for all these patients and likely is an underestimation of the true difference in cost as we did not account for additional visits outside of the initial consultation and follow-up, post-operative visits outside of the global period, emergency room visits, and returns to operating room. Of the circumcisions performed, only 18.5% met Florida Medicaid defined medical indications. Success rates for TST range from 53.8 to 95% in the literature, however, our success rate was 34.3%. The reason for the variation in response rate between our results and the literature may reflect that caretakers desiring circumcision may be less compliant with TST use. Only 6.6% of patients had a documented failure of TST prior to initial presentation. Further education of PCPs on current Medicaid/MCG guidelines for the evaluation and management of phimosis, as well as PCP adoption of TST, could reduce the number of unnecessary office visits, healthcare costs, and family burden.
We performed an IRB approved retrospective chart review of all male Florida Medicaid patients ≥3 years seen at NCH for phimosis/circumcision from Sept. 2016-Sept. 2019. Data extracted included demographics, age at presentation, prior treatment with TST, response to TST, and surgical interventions. The patients were stratified into three management groups. Total costs for each group were based upon estimated Medicaid reimbursement rates. Data were analyzed using descriptive analysis on SPSS.
Seven hundred and sixty-three males were evaluated. Age at presentation ranged from 3 to 17 years and 59% of patients were 3-6 years at initial presentation. Three hundred and forty patients underwent circumcision. The total estimated cost of care for all patients was $1,345,533.90. This compares to an estimated cost of $171,675 if all individuals underwent NC at 2020 costs.
The total estimated cost associated with the evaluation and management of 763 patients ≥3 years for phimosis/circumcision was 7.8 times the estimated cost of NC for all these patients and likely is an underestimation of the true difference in cost as we did not account for additional visits outside of the initial consultation and follow-up, post-operative visits outside of the global period, emergency room visits, and returns to operating room. Of the circumcisions performed, only 18.5% met Florida Medicaid defined medical indications. Success rates for TST range from 53.8 to 95% in the literature, however, our success rate was 34.3%. The reason for the variation in response rate between our results and the literature may reflect that caretakers desiring circumcision may be less compliant with TST use. Only 6.6% of patients had a documented failure of TST prior to initial presentation. Further education of PCPs on current Medicaid/MCG guidelines for the evaluation and management of phimosis, as well as PCP adoption of TST, could reduce the number of unnecessary office visits, healthcare costs, and family burden.
摘要：
背景：2003年，佛罗里达医疗补助停止了常规新生儿包皮环切术（NC）的覆盖，导致非新生儿包皮环切术的增加。佛罗里达医疗补助计划是不涵盖NC的16个州医疗保健计划之一。佛罗里达医疗补助计划涵盖3岁以上儿童的男性包皮环切术，其具有明确的医学适应症或对局部类固醇治疗（TST）难治性的持续性包茎。我们试图评估在Nemours儿童医院治疗≥3岁的佛罗里达医疗补助男性包茎/包皮环切术的评估和管理的经济影响。
方法：我们进行了IRB批准的回顾性图表审查，检查了从9月开始在NCH观察的所有≥3年的男性佛罗里达医疗补助患者包茎/包皮环切术。2016-9月。2019.提取的数据包括人口统计，介绍时的年龄，先前用TST治疗，对TST的回应,和手术干预。将患者分为三个管理组。每组的总费用基于估计的医疗补助报销率。数据采用SPSS描述性分析。
结果：评估了763名男性。就诊年龄为3至17岁，59%的患者在初次就诊时年龄为3-6岁。三百四十名患者接受了包皮环切术。所有患者的估计护理总费用为1,345,533.90美元。相比之下，如果所有个人按2020年的成本接受NC，估计成本为171,675美元。
结论：对763例≥3年包茎/包皮环切术患者进行评估和管理的估计总费用是所有这些患者的NC估计费用的7.8倍，并且可能低估了费用的真实差异，因为我们没有考虑到初始咨询和随访之外的额外就诊，全球时期以外的术后访问，急诊室探视,回到手术室。在进行的割礼中，只有18.5%符合佛罗里达医疗补助定义的医学适应症。文献中TST的成功率从53.8到95%不等，然而,我们的成功率为34.3%。我们的结果与文献之间反应率差异的原因可能反映出希望进行包皮环切术的看护人可能对TST的依从性较差。只有6.6%的患者在初次就诊之前有记录的TST失败。根据当前的Medicaid/MCG指南对PCP进行进一步教育，以评估和管理包茎，以及PCP采用TST，可以减少不必要的办公室访问次数，医疗费用,家庭负担。
方法：我们进行了IRB批准的回顾性图表审查，检查了从9月开始在NCH观察的所有≥3年的男性佛罗里达医疗补助患者包茎/包皮环切术。2016-9月。2019.提取的数据包括人口统计，介绍时的年龄，先前用TST治疗，对TST的回应,和手术干预。将患者分为三个管理组。每组的总费用基于估计的医疗补助报销率。数据采用SPSS描述性分析。
结果：评估了763名男性。就诊年龄为3至17岁，59%的患者在初次就诊时年龄为3-6岁。三百四十名患者接受了包皮环切术。所有患者的估计护理总费用为1,345,533.90美元。相比之下，如果所有个人按2020年的成本接受NC，估计成本为171,675美元。
结论：对763例≥3年包茎/包皮环切术患者进行评估和管理的估计总费用是所有这些患者的NC估计费用的7.8倍，并且可能低估了费用的真实差异，因为我们没有考虑到初始咨询和随访之外的额外就诊，全球时期以外的术后访问，急诊室探视,回到手术室。在进行的割礼中，只有18.5%符合佛罗里达医疗补助定义的医学适应症。文献中TST的成功率从53.8到95%不等，然而,我们的成功率为34.3%。我们的结果与文献之间反应率差异的原因可能反映出希望进行包皮环切术的看护人可能对TST的依从性较差。只有6.6%的患者在初次就诊之前有记录的TST失败。根据当前的Medicaid/MCG指南对PCP进行进一步教育，以评估和管理包茎，以及PCP采用TST，可以减少不必要的办公室访问次数，医疗费用,家庭负担。
