Bayne DB. et al., 2019: Assessing Cost-Effectiveness of New Technologies in Stone Management
Bayne DB, Chi TL.
Urology, University of California San Francisco, San Francisco, CA, USA.
Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.
Urol Clin North Am. 2019 May;46(2):303-313. doi: 10.1016/j.ucl.2018.12.011. Epub 2019 Mar 4. Review.
This article in Urol Clin North Am had the purpose to summarize cost-effectiveness of different methods for stone removal. The authors emphasize this kind of analysis in view of the rising prevalence of stone disease in USA: 3.8% 1976, 5.2% 1994 and 8.4% 2010. It is important to underline, however, that costs vary considerably between different countries, different institutions and organizations with different treatment strategies. Comparing such data is accordingly extremely difficult and the literature contains contradictory conclusions particularly when comparisons are made between SWL, URS, RIRL (RIRS) and PCNL.
In a comparison between the methods mentioned above the authors of this article refer to a report published by Chan et al  from which the following costs were extracted:
SWL US$ 968 (£750)
RIRL US$ 1627 (£1261)
PCNL US$ 3430 (£2658)
There is an apparent advantage for SWL, but only if the procedure can be completed with only one session.
As in several similar reports it is emphasized that appropriate selection of patients is fundamental. In this regard size, composition and location of the stones are important variables to consider in addition to anatomical features. One important remark put forward is that SWL is an excellent alternative when other treatment options are associated with obvious medical risk. On the other hand methods other than SWL should be considered in case of increased medical risk with SWL.
This article is worthwhile to read for everyone who wants an insight in different cost levels for methods, instruments and equipment required for stone removing procedures other than SWL.