Kilonzo MM. et al., 2022: Cost-utility analysis of shockwave lithotripsy vs ureteroscopic stone treatment in adults.
Kilonzo MM, Dasgupta R, Thomas R, Aucott L, MacLennan S, Lam TBL, Anson K, Cameron S, Starr K, Burgess N, Keeley FX, Clark CT, N'Dow J, MacLennan G, McClinton S.
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK.
Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
NHS Grampian, Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
Department of Urology, St Georges University Hospitals NHS Foundation Trust, London, UK.
Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.
Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Bristol Urological Institute, Bristol, UK.
BAUS Section of Endourology Consumer/Patient Advisory Group, London, UK.
Objectives: To assess the cost-effectiveness, resource use implications, quality-adjusted life-years (QALYs) and cost per QALY of care pathways starting with either extracorporeal shockwave lithotripsy (SWL) or with ureteroscopic retrieval (ureteroscopy [URS]) for the management of ureteric stones.
Patients and methods: Data on quality of life and resource use for 613 patients, collected prospectively in the Therapeutic Interventions for Stones of the Ureter (TISU) randomized controlled trial (ISRCTN 92289221), were used to assess the cost-effectiveness of two care pathways, SWL and URS. A health provider (UK National Health Service) perspective was adopted to estimate the costs of the interventions and subsequent resource use. Quality-of-life data were calculated using a generic instrument, the EuroQol EQ-5D-3L. Results are expressed as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.
Results: The mean QALY difference (SWL vs URS) was -0.021 (95% confidence interval [CI] -0.033 to -0.010) and the mean cost difference was -£809 (95% CI -£1061 to -£551). The QALY difference translated into approximately 10 more healthy days over the 6-month period for the patients on the URS care pathway. The probability that SWL is cost-effective is 79% at a society's willingness to pay (WTP) threshold for 1 QALY of £30,000 and 98% at a WTP threshold of £20,000.
Conclusion: The SWL pathway results in lower QALYs than URS but costs less. The incremental cost per QALY is £39 118 cost saving per QALY lost, with a 79% probability that SWL would be considered cost-effective at a WTP threshold for 1 QALY of £30 000 and 98% at a WTP threshold of £20 000. Decision-makers need to determine if costs saved justify the loss in QALYs.
BJU Int. 2022 Jul 29. doi: 10.1111/bju.15862. Online ahead of print. PMID: 35974700
The focus of this article is cost-effective analysis of SWL and URS. The calculations included both direct cost of each of these two interventions as well as estimates of quality-of life data (QoL).
The conclusion was that repeated intervention, as expected, was 11.7% higher for SWL than for URS. Nevertheless, the direct cost for SWL was lower than that of URS (£ 1790 vs. £ 2599). A difference of £ 809.
The authors point out that it also is necessary to consider the loss of QoL which the authors chose to express in terns QALYs. That estimate is the QoL from a questionnaire multiplied with duration of the observation period.
The bottom-line of this extensive cost-effectiveness analysis is that any conclusion on comparison between different treatment methods needs to include data on QoL. It is, however, not easy to fully follow the calculations presented in the article.