Yang SY. et al., 2020: Does Early Retrograde Intrarenal Surgery Improve the Cost-Effectiveness of Renal Stone Management?
Yang SY, Jung HD, Kwon SH, Lee EK, Lee JY, Lee SH.
School of Pharmacy, Sungkyunkwan University, Suwon, Korea.
Department of Urology, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea.
Purpose: This study aimed to evaluate the cost-effectiveness of treatment with retrograde intrarenal surgery (RIRS) versus repeated shock wave lithotripsy (SWL) in patients with renal calculi.
Materials and methods: The non-retreatment rates (NRRs) and their respective real-world costs for RIRS and SWL were derived through retrospective analysis of health insurance claims data from 2015 to 2017. Decision tree modelling was performed to demonstrate the cost-effectiveness of RIRS. Furthermore, sensitivity analysis was performed to examine the robustness of the results.
Results: Analysis of the obtained data showed that NRRs of single SWL ranged from 46% to 56%, whereas NRRs of single RIRS ranged from 75% to 93%. Introducing RIRS early in the treatment sequence was observed to be favorable for the reduction of overall failure (overall NRR, 0.997) compared to the results of repeated SWL (overall NRR, 0.928). The implementation of decision tree modelling revealed that the cost per retreatment-avoided increased with the introduction of RIRS at an earlier time (first line, second line, third line, fourth line: 18640 USD, 10376 USD, 4294 USD, 3377 USD, respectively). Probabilistic modeling also indicated that the introduction of RIRS as the first line of treatment was least likely to be cost-effective, when compared to other options of introducing RIRS as the second, third, or fourth line of treatment.
Conclusion: Performing RIRS as early as possible can be recommended for eligible patients to reduce the overall failure, even if it is not as cost-effective as performing RIRS later.
Yonsei Med J. 2020 Jun;61(6):515-523. doi: 10.3349/ymj.2020.61.6.515.PMID: 32469175. FREE ARTICLE
The authors of this report form South Korea were able to carry out a cost-effective analysis of patients treated with SWL and/or RIRS in five different settings:
RIRS+ RIRS/SWL+ RIRS/SWL+ RIRS/SWL
Treatments were continued up to four sessions until success was obtained. Success =” non-retreatment”; NRR). Failure=”re-treatment”
The economic considerations were based on re-imbursement claims to the Health Insurance Review and Assessment Service in Korea. No information was provided on the clinical stone problem, but the assumption was that for each patient it was possible to solve the problem with maximally four treatment sessions (1-4).
11700 patients were included in the analysis of whom 90.5% had SWL as first line treatment while 9.5% initially were treated with RIRS. The best outcome with SWL was 56% and that of RIRS 75-93%. SWL overall NRR 0.928; RIRS overall NRR 0.997.
Cost of first SWL = USD 840
Cost of first RIRS = USD 2555
The conclusion was that when RIRS was carried out early NRR was highest, but early RIRS was not as cost effective as when RIRS was carried out later. But it was noted that RIRS was the best option to reduce treatment failure.
It should be noted that the reimbursement principles are those applied in South Korea and that the economic conclusions not directly can be transferred to those in other countries. Nevertheless, it is possible that their conclusions are valid also in other parts of the world. That is: RIRS early is best to reduce treatment failure, but later RIRS is more cost-effective.