Nedbal C. et al., 2025: Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature.
Carlotta Nedbal 1 2, Pietro Tramanzoli 1 2, Daniele Castellani 2, Vineet Gauhar 3, Andrea Gregori 1, Bhaskar Somani 4
1Urology Unit, ASST Fatebenefratelli Sacco, Milano.
2Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Le Marche, Ancona, Italy.
3Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore.
4Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK.
Abstract
Purpose of review: To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies.
Recent findings: A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS.
Summary: Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays' practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.
Curr Opin Urol. 2025 Jul 1;35(4):368-376. doi: 10.1097/MOU.0000000000001216. Epub 2024 Aug 19. PMID: 39162117
Comments 1
This a very detailed report on endourology costs of stone treatment.
There is no doubt that knowing the costs is important. But it is only helpful for benchmarking within an identical (health-) system. Any comparison beyond that creates confusion (1). For example, the present study reports a variability in the costs of ESWL of > 400% (2). The significance of these differences can only be understood if the basis for the calculations is known. Drawing practical conclusions from this may be hampered by the system in which the figures are recorded. For example, if the salary for the practitioner differs across countries, hospitals, or departments.
1 Canvasser NE, et. al The economics of stone disease. World J Urol. 2017 Sep;35(9):1321-1329. doi: 10.1007/s00345-017-2003-y. Epub 2017 Jan 20. PMID: 28108799.
2 Nedbal C, et al. Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature. Curr Opin Urol. 2025 Jul 1;35(4):368-376. doi: 10.1097/MOU.0000000000001216. Epub 2024 Aug 19. PMID: 39162117.
Peter Alken