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Cone EB et al, 2014: Cost-Effectiveness Comparison of Renal Calculi Treated with Ureteroscopic Laser Lithotripsy Versus Shockwave Lithotripsy

Cone EB, Eisner BH, Ursiny M, Pareek G
Division of Urology, Duke University Medical Center, Duke University School of Medicine , Durham, North Carolina


Abstract

PURPOSE: To evaluate the cost-effectiveness of shockwave lithotripsy (SWL) vs ureteroscopic lithotripsy (URS) for patients with renal stones

METHODS: Patient age, stone diameter, stone location, and stone-free status were recorded for patients treated with SWL or URS for renal stones

RESULTS: One hundred fifty-eight patients were included in the study-78 underwent SWL and 80 underwent URS as primary treatment. Single procedure stone-free rates (SFR) for SWL and URS were 55% and 95%, respectively (P<0.0001). Decision analysis modeling demonstrated cost-effectiveness of SWL when SWL single procedure SFR were 65% to 67% or when URS single procedure SFR was 72% to 84%.

CONCLUSIONS: This retrospective study revealed superior SFR results for renal stones

J Endourol. 2014 Feb 14. [Epub ahead of print]
PMID:24444144[PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Monday, 24 March 2014 13:56

Economic analyses are of significance only for that country and health organization system in which they are carried out. In this report from USA, from which it is concluded that URS is more cost-effective than SWL, some interesting observations can be made.

First it is of note that for both procedures the anaesthesia-fee was the dominant factor. If administration of analgesic and sedative agents, required for SWL, had been made by the treating urologist, it is obvious that the cost for that procedure would have been much lower than that for URS.

Second, it is surprising, that while it is considered necessary with a great expertise for URS (one urologist carried out all 80 URS procedures), it is stated that as little as 10 procedures per year, while overlooking a technician (!), was enough for SWL. But it is of course difficult to know whether greater SWL experience with the used lithotripter had resulted in a higher stone free rate than 55% for

Third, the interpretation of freedom of fragments was not necessarily the best end-point for these patients inasmuch as another 25 patients in group 1 had asymptomatic fragments. This means that 43+25 = 68 patients (87%) had a clinically satisfactory outcome after SWL (clinical end-point). In order to draw economic conclusions it is necessary also to find out the economic burden of these patients in the future.

Fourth, even if asymptomatic residuals are considered a failure, it is probably too early to conclude on definite stone-free rates already 30 days after SWL.

Hans-Göran Tiselius

Economic analyses are of significance only for that country and health organization system in which they are carried out. In this report from USA, from which it is concluded that URS is more cost-effective than SWL, some interesting observations can be made. First it is of note that for both procedures the anaesthesia-fee was the dominant factor. If administration of analgesic and sedative agents, required for SWL, had been made by the treating urologist, it is obvious that the cost for that procedure would have been much lower than that for URS. Second, it is surprising, that while it is considered necessary with a great expertise for URS (one urologist carried out all 80 URS procedures), it is stated that as little as 10 procedures per year, while overlooking a technician (!), was enough for SWL. But it is of course difficult to know whether greater SWL experience with the used lithotripter had resulted in a higher stone free rate than 55% for Third, the interpretation of freedom of fragments was not necessarily the best end-point for these patients inasmuch as another 25 patients in group 1 had asymptomatic fragments. This means that 43+25 = 68 patients (87%) had a clinically satisfactory outcome after SWL (clinical end-point). In order to draw economic conclusions it is necessary also to find out the economic burden of these patients in the future. Fourth, even if asymptomatic residuals are considered a failure, it is probably too early to conclude on definite stone-free rates already 30 days after SWL. Hans-Göran Tiselius
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