Variation in ureteric re‐implantation for Australian children

Abstract

Background Management options for vesicoureteric reflux are numerous, increasingly diversifying and debated. There is longstanding anecdotal opinion of inexplicable regional variation in vesicoureteric reflux management in Australia. This study investigates temporal trends in ureteric re‐implantation for children, and variation between states and territories. Methods Ureteric re‐implantation data for children aged 0–14 years were retrieved from the Medicare Benefits Scheme item reports database for the 20‐year period from 1998–2017. Claims data were population adjusted for each state then standardized for age using Australian Bureau of Statistics records. National and regional trends were calculated using joinpoint regression. Comparison between eastern (New South Wales, Victoria, Queensland, Tasmania, Australian Capital Territory) and western or central (Western Australia, South Australia) states was performed using the Mann–Whitney U‐test. Results There were 4919 procedure rebate claims during the study period. A national decrease in claim rates of 6.3% per 100 000 children was identified (P < 0.001). This was derived from significant decreases observed in eastern states. There was a threefold higher claim rate in Western Australia and South Australia per annum compared to the remainder of the country (4.0 versus 12.6 per 100 000; P < 0.001). For the most recent 5 years of the study period, this difference increased to a sevenfold higher rate (1.6 versus 11.1; P < 0.001). Conclusion There has been a dramatic nationwide decline in the rate of ureteric re‐implantation procedure claims. Regional disparity between each side of the country is widening. Further research is required to determine if this degree of variation is warranted or unwarranted. The observed regional variation facilitates opportunity for a nationwide pragmatic clinical trial.

Early childhood circumcision in Australia: Trends over 20 years and interrupted time series analysis

“…We also cannot account for procedures that do not attract an MBS rebate, such as those performed on a purely fee‐for‐service basis 21 . Nevertheless, such data have been validated in other paediatric urological procedures including ureteric re‐implantation 33 and orchidopexy 34 . Second, MBS codes do not differentiate procedures based on indication.…”