Albino G et al, 2017: Who "apparently" more spends, "in reality" spends less. Spending "a little" more for the rental of the extracorporeal lithotripter can save "a lot" about the days of hospitalization for urinary stones.
Albino G, Albergo F.
UOC of Urology, "L. Bonomo" Hospital, Andria, ASL BAT.
OBJECTIVE: The right to health (according to the Article 32 of the Italian Republic Constitution) is financially conditioned; for this reason the National Health System (NHS) has the objective of rationalize health expenditure according to the criteria of efficiency, effectiveness and economy. This paper is an example of rationalization concerning the extracorporeal shock wave lithotripsy (ESWL).
MATERIALS AND METHODS: Hospital admissions for urinary stones were taken into account. "Edotto", the database of the Puglia region has identified 23 inpatient admissions during which was performed ESWL. A single operator performed ESWLs with a Storz lithotripter, Modulith SLK.
RESULTS: The average hospital stay is conditioned by days "to wait" lithotripsy. In 2014 the hospitalization days "waiting for" lithotripsy were 100. The results were subjected to SWOT analysis and discussed with the Boston Consulting Group Matrix.
DISCUSSION: Constant availability of the lithotripter would spare 100 days of hospitalization, amounting to € 88,200.00. This waste of resources corresponds to an additional cost equal to 98.3% on the cost for the rental of the lithotripter. Instead, reducing "unnecessary" hospitalization days would get a saving of 79.3% on the rental cost. It is as if for 46 days of the lithotripter rent were paid 46 days, while for 365 days of the lithotripter rent were paid only 11.8 sessions per year.
CONCLUSIONS: Rationalization of resources is not necessarily a synonym of "reduction" of resources, but of reduction of waste in the NHS. A good plan is the most important rational basis to get more resources. About the process taken into account it is seen as an investment of € 21,450.00 would keep unchanged the effectiveness of lithotripsy service but would add efficiency and economy (increase of sessions/year, increase in the active mobility, increase in orthopedic treatments) and would drastically reduce the number hospital days (a waste).
Arch Ital Urol Androl. 2016 Dec 30;88(4):325-329. doi: 10.4081/aiua.2016.4.325
This report comprises an interesting series of economic considerations in support of a stationary SWL facility. Although the economic conditions definitely differ from one country to another it is obvious that a major advantage of immediate or early SWL is to avoid numerous days of hospitalization.
The economic saving is one part of this issue, but the other part is that the results of SWL for ureteral stones are much better with early than late treatment.
It is my personal assumption that if a lithotripter is not always available and if possibilities for early SWL of these patients are poor, too many will be treated with URS rather than non-invasively with SWL.
My recommendation is to organize the lithotripter service in a way that enables early treatment of ureteral stones.