Konnopka C. et al., 2022: Long-term evaluation of outcomes and costs of urolithiasis re-interventions after ureteroscopy, extracorporeal shockwave lithotripsy and percutaneous nephrolithotomy based on German health insurance claims data.
Konnopka C, Becker B, Netsch C, Herrmann TRW, Gross AJ, Lusuardi L, Knoll T, König HH.
Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany.
Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria.
Department of Urology, Klinikum Sindelfingen-Boeblingen, Sindelfingen, Germany.
Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Abstract
Purpose: Comparisons of ureteroscopy (URS), extracorporeal shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) for urolithiasis considering long-term follow-up are rare. We aimed to analyze re-intervention rates, costs and sick leave days of URS, SWL and PCNL patients within 7 years.
Methods: This retrospective cohort study was based on German health insurance claims data. We included 54,609 urolithiasis patients incidentally treated in 2008-2010. We investigated time to re-intervention, number of sick leave days and healthcare costs. We applied negative binomial, extended Cox regression and gamma models.
Results: 54% were incidentally treated with URS, 40% with SWL and 6% with PCNL. 15% of URS, 26% of SWL and 23% of PCNL patients were re-treated within 7 years. Time to re-intervention was significantly lower for PCNL (955 days) and SWL (937 days) than URS (1078 days) patients. Costs for incident treatment were significantly higher for PCNL (2760€) and lower for SWL (1342€) than URS (1334€) patients. Yet, total costs including re-interventions were significantly higher for PCNL (5783€) and SWL (3240€) than URS (2979€) patients. Total number of sick leave days was increased for PCNL (13.0 days) and SWL (10.1 days) compared to URS (6.8 days) patients.
Conclusion: This study describes outcomes after use of different intervention options for urolithiasis. URS patients showed longest time free of re-interventions and lowest number of sick leave days. Although SWL patients initially had lower costs, URS patients had lower costs in the long run. PCNL patients showed high costs and sick leave days.
World J Urol. 2022 Dec;40(12):3021-3027. doi: 10.1007/s00345-022-04180-3. Epub 2022 Oct 14. PMID: 36239809. FREE ARTICLE
Comments 1
In the discussion on which treatment modality that is best, long-term follow-up is an important variable. Re-interventions after URS, SWL, and PCNL were analyzed in ~55 000 German patients during a period of 7 years after the primary treatment.
Only 20% of the patients were re-treated during the follow-up period. It is reasonable to assume that a major proportion of patients were treated because of growth of residual fragments, but some patients might also have been treated for new stone formation in initially fragment/stone-free renal collecting systems. In this regard the stone composition plays a major role. I cannot see if the authors distinguished between treatment of ureteral and renal stones, but more ureteral stones might speak in favor of URS, because it is unlikely that any residuals in the ureter have caused late re-treatment.
The health-economic considerations are difficult to apply in health organizations other than the German, because obviously all patients were treated as in-patients In Sweden all SWL-treatments (with very few exceptions) are carried out in an out-patient setting.
The observation in the current study that sick leave was longer for SWL (and PCNL) than for URS is indeed surprising.
The data presented in the current report corresponds well with my own observation that patients treated with SWL required repeated SWL in approximately 20% after 7 years, or 3% per year in 140 patients with residual kidney stones.
Hans-Göran Tiselius