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Matlaga BR et al, 2012: Economic Outcomes of Treatment for Ureteral and Renal Stones: A Systematic Literature Review

Matlaga BR, Jansen JP, Meckley LM, Byrne TW, Lingeman JE
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland


Abstract

PURPOSE: We evaluated the cost-effectiveness of ureteral/renal stone treatment by comparing ureteroscopy, extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.

MATERIALS AND METHODS: We performed a systematic literature search to identify studies of treatment for adults with ureteral and renal stones that were published between 1995 and 2010. For inclusion in analysis studies had to provide the stone-free rate and the cost of at least 2 therapies.

RESULTS: Ten studies were identified, including 8 with an observational design and 2 that synthesized data using decision modeling techniques. Five of 6 studies, including 1 of 2 from the United States, compared ureteroscopy vs shock wave lithotripsy for proximal stones and showed a higher stone-free rate and lower cost for ureteroscopy. Four of the 5 studies, including the only American study, compared ureteroscopy vs shock wave lithotripsy for distal ureteral stones and also showed such an economically dominant result. Studies of shock wave lithotripsy vs percutaneous nephrolithotomy and ureteroscopy vs percutaneous nephrolithotomy for renal stones demonstrated higher cost and a higher stone-free rate for percutaneous nephrolithotomy.

CONCLUSIONS: Despite the great heterogeneity and limited quality of available cost-effectiveness evaluations most studies demonstrated that ureteroscopy was more favorable than shock wave lithotripsy for ureteral stones in stone-free rate and cost.

Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
J Urol. 2012 Aug;188(2):449-54. doi: 10.1016/j.juro.2012.04.008. Epub 2012 Jun 13
PMID: 22698623 [PubMed - in process]

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Comments 1

Peter Alken on Friday, 17 February 2012 07:32

The issue of costs becomes increasingly important and seems to influence the choice between alternative procedures. But the basis for this choice is poor. This literature review does not answer the question if URS or ESWL is more cost effective: only 10 studies on the subject were found in 16 years and the quality of the 10 studies was poor (4), fair (4) and high (2). "We found a relative dearth of studies of the cost-effectiveness of surgical stone treatment and those that we found were often not well done."

How to measure the quality of economic studies may be the best hint the paper gives: the interested reader might have a look at: Comparison of three instruments assessing the quality of economic evaluations: A practical exercise on economic evaluations of the surgical treatment of obesity. Gerkens S et al. International Journal of Technology Assessment in Health Care, 24:3 (2008), 318–325.

P.S.: I was not aware of the fact that there are "second, third or fourth generation HM3 lithotripters" on the market.

Peter Alken

The issue of costs becomes increasingly important and seems to influence the choice between alternative procedures. But the basis for this choice is poor. This literature review does not answer the question if URS or ESWL is more cost effective: only 10 studies on the subject were found in 16 years and the quality of the 10 studies was poor (4), fair (4) and high (2). "We found a relative dearth of studies of the cost-effectiveness of surgical stone treatment and those that we found were often not well done." How to measure the quality of economic studies may be the best hint the paper gives: the interested reader might have a look at: Comparison of three instruments assessing the quality of economic evaluations: A practical exercise on economic evaluations of the surgical treatment of obesity. Gerkens S et al. International Journal of Technology Assessment in Health Care, 24:3 (2008), 318–325. P.S.: I was not aware of the fact that there are "second, third or fourth generation HM3 lithotripters" on the market. Peter Alken
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