Background:
The use of dextranomer/hyaluronic acid copolymer (Deflux) has become increasingly popular as an alternative to medical management for the treatment of vesicoureteral reflux. We examine the cost effectiveness of performing Deflux injection in patients who would otherwise undergo medical management.
Methods:
A model for managing vesicoureteral reflux has previously been created. This model allowed for calculation of the costs of managing reflux in a theoretical population of girls over a 5 year period. Medical management consisted of antibiotic prophylaxis with annual VCUG and ultrasound, with open ureteral reimplantation reserved for breakthrough pyelonephritits or for nonresolution at 5 years. Two scenarios were examined concerning the usage of Deflux in patients who would otherwise undergo medical management: 1. Initial Deflux injection, proceeding to medical management upon failure, 2. Initial Deflux injection, proceeding to ureteral reimplantation upon failure. A threshold level of success of Deflux for cost equivalency to medical management was calculated for each grade of reflux for both unilateral and bilateral reflux.
Results:

Threshold Deflux Success Rate to Achieve Cost Equivalence to Medical Management (Scenario 1)

Reflux Grade	Unilateral	Bilateral
I	Never	Never
II	Never	Never
III	68%	52%
IV	45%	41%
V	36%	33%

Threshold Deflux Success Rate to Achieve Cost Equivalence to Medical Management (Scenario 2)

Reflux Grade	Unilateral	Bilateral
I	Never	Never
II	Never	Never
III	75%	64%
IV	55%	50%
V	40%	75%

Conclusions:
Initial Deflux injection is never cost-equivalent to medical management in grades I and II of reflux. If Deflux success reaches threshold levels, initial Deflux injection can be cost-equivalent to medical management in grades III, IV, and V of reflux.

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