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Management of Undescended Testis : A Decision Analysis

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Author: Akker-van Marle, M.E. van den · Kamphuis, M. · Gameren-Oosterom, H.B.M. van · Pierik, F.H. · Kievit, J.
Type:article
Date:2013
Source:Medical Decision Making, 7, 33, 906-919
Identifier: 473996
doi: doi:10.1177/0272989X13493145
Keywords: Health · Cryptorchidism · Decision analysis · Orchidopexy · Biomedical Innovation · Healthy Living · Human Earth & Environment Triskelion BV · ARF - Analytical Research (Food) CH - Child Health UES - Urban Environment & Safety · BSS - Behavioural and Societal Sciences EELS - Earth, Environmental and Life Sciences TNO Bedrijven

Abstract

Background. Undescended testis (UDT) or cryptorchidism is the most common genital anomaly seen in boys and can be treated surgically by orchidopexy. The age at which orchidopexy should be performed is controversial for both congenital and acquired UDT. Methods. A decision analysis is performed in which all available knowledge is combined to assess the outcomes of orchidopexy at different ages. Results. Without surgery, unilateral congenital UDT and bilateral congenital UDT are associated with average losses in quality-adjusted life-years (QALYs) of 1.53 QALYs (3% discounting 0.66 QALYs) and 5.23 QALYs (1.91 QALYs), respectively. Surgery reduces this QALY loss to on average 0.84 QALYs (0.21 QALYs) for unilateral UDT and 1.66 QALYs (0.40 QALYs) for bilateral UDT. Surgery at detection will lead to the lowest QALY loss of 0.91 (0.34) and 1.73 (0.60) QALYs, respectively, for unilateral and bilateral acquired UDT compared with surgery during puberty and no surgery. No sensitivity analysis is able to change the preferences for these strategies. Conclusions. Based on our decision analytic model using societal valuations of health outcomes, surgery for unilateral UDT (both congenital and acquired) yielded the lowest loss in QALYs. Given the modest differences in outcomes, there is room for patient (or parent) preference with respect to the performance and timing of surgery in case of unilateral UDT. For bilateral UDT (both congenital and acquired), orchidopexy at any age provides considerable benefit, in particular through improved fertility. As there is no strong effect of timing, the age at which orchidopexy is performed should be discussed with the parents and the patient. More clinical evidence on issues related to timing may in the future modify these results and hence this advice.