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Screening for Hematuria

Perry A. Lambird, MD, MBA
JAMA. 1990;263(13):1763. doi:10.1001/jama.1990.03440130043011.
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To the Editor.—  The conclusion by Woolhandler et al that urine screening for hematuria and proteinuria is inappropriate is not justified.1 The opposite conclusion can be drawn from the data.Considering only hematuria from population-based studies (Table 1 in the article by Woolhandler et al1), the following cost table may be constructed. Estimates are derived from our local health and liability carrier experience.Screening costs Screening 123172 individuals × $3 = $369 516 Workups 1222 × $500 = $611 000 Complications of workups: Operations—1222 × 0.2% × $10 000 = $24 440 Renal failure—1222 × 0.15% × 10 000 = $18 330 Deaths (malpractice settlement)— 1222 × 0.002% × $1 000 000 = $24 400 Total = $1047 726Malpractice costs of failure to screen (significant disease present but failure to diagnose) 1222 × 1.5% (documented rate) × $400 000 (average failure to diagnose settlement) = $7 332 000 1222 × 0.5% (estimated occurrence rate) × $400


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