Rombi T et al, 2012: Socioeconomic evaluation of the treatment of ureteral lithiasis
Rombi T, Triantafyllidis A, Fotas A, Konstantinidis T, Touloupidis S
Abstract
BACKGROUND AND AIM: This study attempts to estimate the socioeconomic differences between three major alternatives for the management of upper and lower ureteral lithiasis.
MATERIAL AND METHODS: Two hundred and forty patients with upper and lower ureteral lithiasis, have been studied retrospectively, divided in six equal groups of forty. These patients have been treated either by extracorporeal shockwave lithotripsy (SWL), or with ureteroscopy with semirigid ureteroscope and the use of pneumatic lithoclast, or with ureteroscopy with flexible ureteroscope and the use of Holmium YAG Laser. For cost calculation, the reimbursement fee paid by insurance to the hospital was taken into account. For the estimation of the social burden, the length of hospital stay and the number of outpatient visits have been included as countable parameters.
RESUTLS: The percentage of effective stone removal for upper ureter was 81.0% for SWL, 62.5% for ureteroscopy with semirigid ureteroscope and the use of pneumatic lithoclast and, 82.5% for ureteroscopy with flexible ureteroscope and the use of Holmium YAG Laser. The same percentages for lower ureter were 82.5%, 92.5% and 97.5% respectively. The cost of stone removal for both the upper and lower ureter using extracorporeal lithotripsy was significantly higher compared to the other two procedures (median cost for upper ureter 828 € vs 474.50 € and 396 € respectively, and for lower ureter 826 € vs 396 € and 271 €, p<0.001). Regarding the social aspect, SWL is mainly an outpatient procedure, requiring a short hospital stay (for upper ureter 1.63 vs 2.48 and 2.45 respectively and for lower ureter 1.35 vs 2.43 and 2.13days), but needing more and prevailing clinic visits (for upper ureter 1.43 vs 1.45 and 1 respectively and for lower ureter 1.45 vs 1.15 and 0.55 visitsgive numbers, compare), both in outpatient and in accident and emergency (A&E) department.
CONCLUSION: The increase in the expenses with regard to health management indicates the necessity of cost accounting the health programs including the medical procedures as a means to improve the relation between cost and benefit.
Hippokratia. 2011 Jul;15(3):252-7
PMID:22435024 [PubMed]. FREE ARTICLE
Comments 1
Treatment results in an economic perspective was analysed for upper and distal ureteral stones treated with ESWL (Lithostar) [A], semirigid URS + pneumatic lithotripsy [B] or flexible URS with holmium YAG laser lithotripsy [C]. It is almost impossible to compare economics between different countries and this repost is an example of that difficulty. Despite the need of general or regional anaesthesia for treatments B and C, the authors´ conclusion is that that the median cost for ESWL was twice as high as that for methods B and C. This is a finding that is contradictory to several other current reports and the explanation can probably be found in local economic conditions. One explanation given in the report is the need of more out-patient visits, but that aspects not elaborated in more detail.
Hans-Göran Tiselius