Koo V et al, 2011: Cost-effectiveness and efficiency of shockwave lithotripsy vs flexible ureteroscopic holmium:yttrium-aluminium-garnet laser lithotripsy in the treatment of lower pole renal calculi
Koo V, Young M, Thompson T, Duggan B.
Stone Treatment Centre, Craigavon Area Hospital, Portadown, and Department of Urology, Belfast City Hospital, Belfast, Northern Ireland, UK.
Study Type - Therapy (cost effectiveness) Level of Evidence 2b.
What's known on the subject? and What does the study add?
Stone management economics is a complex issue. FURS and SWL are recognised treatment option for lower pole kidney stones. There are paucity of data comparing cost implication and effectiveness of both treatment options. Both treatment modalities are equally efficacious. FURS incurred greater cost burden compared to SWL in the UK setting. In the present economic circumstance, clinicians should also consider cost-impact, patient's preference and specific clinical indication when counselling patients for treatment.
- To compare the cost-effectiveness and outcome efficiency of extracorporeal shockwave lithotripsy (SWL) vs intracorporeal flexible ureteroscopic laser lithotripsy (FURS) for lower pole renal calculi ≤20 mm.
PATIENTS AND METHODS:
- Patients who had treatment for their radio-opaque lower pole renal calculi were categorized into SWL and FURS group.
- The primary outcomes compared were: clinical success, stone-free, retreatment and additional procedure rate, and perceived and actual costs.
- Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments
- Perceived cost was defined as the cost of procedure alone, and the actual cost included the cost of additional procedures as well as the overhead costs to result in clinical success.
- The FURS (n= 37) and SWL (n= 51) group were comparable with respect to sex, age, stone size and the presence of ureteric stent.
- The final treatment success rate (100% vs 100%), stone-free rate (64.9% vs 58.8%), retreatment rate (16.2% vs 21.6%) and auxillary procedure rate (21.6% vs 7.8%) did not differ significantly.
- The mean perceived cost of each FURS and SWL procedure was similar (£249 vs £292, respectively); however, when all other costs were considered, the FURS group was significantly more costly (£2602 vs £426, P= 0.000; Mann-Whitney U-test).
- SWL was efficacious and cost-effective for the treatment of lower pole renal calculi ≤20 mm.
© 2011 THE AUTHORS; BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
BJU Int. 2011 Dec;108(11):1913-6. doi: 10.1111/j.1464-410X.2011.10172.x. Epub 2011 Mar 31
PMID: 21453346 [PubMed - indexed for MEDLINE]. FREE ARTICLE
In a retrospective analysis then authors have compared the cost of flexible ureteroscopy (FURS) and ESWL for removal of stones located in the lower pole of the kidney. Despite the lack of a randomization the patients and stones in the two groups were comparable.
It is of note that although 100% success was reported, stone-free kidneys were obtained in 65% of the FURS patients and in 59% of the ESWL patients. Interestingly there were similar re-treatment rates of 16.2% in the FURS patients and 21.6% in the ESWL patients. The overall treatment time and hospital stay was longer for patients treated with FURS than for those treated with ESWL.
From an economic point of view the total cost for FURS was significantly higher than that for ESWL.
Although it had been desirable with a randomized study these data are of interest inasmuch as they show that contrary to what is often believed FURS is not always a one session procedure without complications and definitely not less expensive than ESWL.