Romeu G. et al., 2021: Comparing extracorporeal shock wave lithotripsy and ureteroscopy laser lithotripsy for treatment of urinary stones smaller than 2 cm: a cost-utility analysis in the Spanish clinical setting
Romeu G, Marzullo-Zucchet LJ, Díaz J, Villarroya S, Budía A, Ordaz DG, Caballer V, Vivas D.
Urology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain. Urology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Centro de Investigación en Economía y Gestión de la Salud (CIEGS), Universitat Politècnica de València, Valencia, Spain.
Purpose: To analyze the efficiency and cost-utility profile of ureteroscopy versus shock wave lithotripsy for treatment of reno-ureteral stones smaller than 2 cm.
Methods: Patients treated for urinary stones smaller than 2 cm were included in this study (n = 750) and divided into two groups based on technique of treatment. To assess the cost-utility profile a sample of 48 patients (50% of each group) was evaluated. Quality of life survey (Euroqol 5QD-3L) before-after treatment was applied, Markov model was designed to calculate quality of life in each status of the patients (stone or stone-free with and without double-J stent) and to estimate the incremental cost-utility. Monte carlo simulation was conducted for a probabilistic sensitivity analysis. Chi-square was used for comparing qualitative variables and T student's for continuous variables.
Results: Shock wave lithotripsy group had 408 (54.4%) and ureteroscopy group had 342 (45.6%) patients. Of them, 56.3% were treated for renal stones and 43.7% for ureteral stones. Ureteroscopy produced slightly higher overall quality of patients' life, but produced a significant higher overall cost per quality-adjusted life year (QALY) than shock wave lithotripsy, exceeding the cost-utility threshold (20,000€/QALY). Sensitivity analysis confirmed results in 93.65% of cases. Difference was maintained in subgroup analysis (ureteral vs renal stones).
Conclusions: Results suggest that in our clinical setting shock wave lithotripsy has better cost-utility profile than ureteroscopy for treatment of reno-ureteral stones less than 2 cm, but excluding waiting times, in ideal clinical setting, ureteroscopy would have better cost-utility profile than shock wave lithotripsy.
World J Urol. 2021 Feb 22. doi: 10.1007/s00345-021-03620-w. Online ahead of print. PMID: 33616709.
It is refreshing to read not just another “We-too”-did-a-hundred-cases-of…paper.
“This study belongs to a bigger research project started in 2012 and still going on to evaluate our own cost-effectiveness and cost-utility profile in all possible scenarios of stone treatment.”
Research and publications like this are needed to move to a more cost sensitive and more patient orientated medical profession.
Among the limitations of the study the authors mention: “…we applied the EQ-5D questionnaire, a generic HRQOL assess tool, not specific for urinary stone patients. It would be interesting to develop a specific HRQOL questionnaire.”
I wonder why they did not mention nor use the Wisconsin Stone-QOL Questionnaire, which is the only Urolithiasis specific questionnaire https://urology.wisc.edu/wp-content/uploads/2018/10/Wisconsin_Stone_Quality_of_Life_Questionnaire.pdf