Monga M. et al., 2023: Prevalence of Stone Disease and Procedure Trends in the United States.
University of California San Diego School of Medicine, San Diego, CA.
Boston Scientific, Marlborough, MA.
Boston Scientific, Marlborough, MA.
Boston Scientific, Marlborough, MA.
Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Abstract
Objective: To evaluate the prevalence of stone disease and procedure trends among US commercial and Medicare populations.
Methods: Retrospective analyses for a US commercial population and Medicare population were conducted using the Merative MarketScan Commercial Database and Medicare Standard Analytic File (5% sample), respectively. Patients aged 18+ were included if they had an encounter in any setting with a primary stone diagnosis or stone procedure (ureteroscopy [URS], percutaneous nephrolithotomy (PCNL), or shockwave lithotripsy [SWL]) between 2011 and 2019. Analyses were conducted at the patient level.
Results: Over the study time horizon, the prevalence of stone disease showed a small yet statistically significant decrease in the commercial population (1.04%-1.01%; P < 0.0001) and a statistically significant increase in the Medicare population (1.84%-2.34%; P < 0.0001). URS procedure volumes increased by 22.6% (P < 0.0001) in the commercial population and by 56.6% (P < 0.0001) in the Medicare population over the study period. Similarly, PCNL procedure volumes increased by 17.4% (P < 0.0001) in the commercial population and 27.5% (P < 0.0001) in the Medicare population. Procedure volumes for SWL decreased by 26.9% in the commercial population (P < 0.0001) and by 3.8% in the Medicare population although the results were not statistically significant.
Conclusion: The prevalence of stone disease showed a small decrease in the US commercial population and an increase in the Medicare population over the study time horizon. In both populations, increasing procedure volumes were observed for URS and PCNL while decreasing volumes were observed for SWL.
Urology. 2023 Apr 14:S0090-4295(23)00313-8. doi: 10.1016/j.urology.2023.03.040. Online ahead of print.PMID: 37062518
Free article.
Comments 1
The most informative epidemiological publications come from the USA as they are based on well-developed data banks. Whenever I read these articles I am surprised about the relations they depict without expressively addressing them. They offer views in the American society and in the financially driving forces. This last aspect is very important for a country with the highest health care cost worldwide. The authors state: “Most epidemiological studies of stone disease rely on survey data rather than healthcare claims data. Estimates based on claims data may be more reliable than those from patient-reported data from national or international surveys. The objectives of this retrospective study were to (1) examine the prevalence of stone disease in the United States and (2) evaluate recent trends in the surgical management of stone disease in both the US commercial and Medicare populations over the past decade using healthcare claims data.” “Money makes the world go round!”

Unfortunately, the information provided is not applicable to the situation in other countries with different health systems. In addition, the casual reader is not familiar with the US insurance system (a glimpse on it is offered in Fig.1) and hospital system, the coding rules and especially not with the incentives of the reimbursement system driving the therapeutic choices.
Consequently, the authors mention as a limitation “for the commercial analysis, the benefit designs of employer-sponsored health plans (ie, preferred prior authorization requirements or preferred procedure tiers) could not be determined from the claims database, which may potentially impact the choice of procedure.”
Factors like these may explain why for instance the prevalence is supposed to be higher in the Medicare group or why PNL is ~ 8 % more frequent in the Medicare group through the years. Both facts are not caused by renal stones!
Peter Alken