Zekraoui O. et al., 2026: Costs of resolving a ureteral or kidney stone episode worldwide: a systematic review.

Zekraoui O, Moussa I, Lee N, Nguyen DD, Guennoun A, Bouhadana D, Murad L, Siron N, Chen K, Bhojani N.
Urol Nephrol. 2026 Apr;58(4):1141-1159. doi: 10.1007/s11255-025-04784-9. Epub 2025 Sep 15.

Abstract

Purpose: This systematic review compares the costs of common urolithiasis surgical options worldwide, identifies sources of heterogeneity in cost reporting, and propose recommendations for standardizing economic evaluations with the aim of reducing urolithiasis' financial burden globally.

Methods: We systematically searched Medline, EMBASE and Web of Science for studies published between 2014 and 2024. Included studies involved adult patients treated for a urolithiasis, described components of cost calculations, and provided a monetary value. Data was summarized qualitatively, and costs were first inflated, then converted to 2024 USD for comparability.

Results: After identifying 2,461 references, 38 studies from 13 countries met the inclusion criteria. Variations in the definition of stone-free status were noted, with 17 studies not specifying it at all. While most studies accounted for procedural and hospital stay costs, the rest of the cost calculation components varied significantly. The costs of managing an episode with URS ranged from 249.12 to 48,937 USD, as for ESWL, the costs ranged from 177.48 to 10,184.64 USD. The costs of managing an episode using PCNL presented the largest disparity, ranging from 164.89 to 101,510.23 USD. Finally, studies assessing the management using MET reported costs from 293.89 to 17,982.19 USD.

Conclusion: Our review highlights substantial variability in urolithiasis treatment costs worldwide. Standardizing cost calculation methods and clinical success definitions is critical for guiding cost-effective decision-making and supporting evidence-based strategies to optimize resource allocation and reduce urolithiasis' financial burden globally.

Comment Peter Alken

Great Job! I still vividly remember how frustrated I was when I helped compile a similar cost overview (1). The problem begins with the fact that the underlying clinical raw data is neither standardized nor comparable—a difficulty that is multiplied when one attempts to create a comprehensive overview of costs. This process consequently generates completely wild figures, such as a cost range in the present paper  from  164.89 to 101,510.23 USD for PNL. Nevertheless, it remains a very valuable document for a reader who is interested in costs.

1 Canvasser NE, Alken P, Lipkin M, et al. The economics of stone disease. World J Urol. 2017 Sep;35(9):1321-1329. doi: 10.1007/s00345-017-2003-y.

Peter Alken