Zhang J et al, 2011: Cost-effectiveness analysis of ureteroscopic laser lithotripsy and shock wave lithotripsy in the management of ureteral calculi in eastern china
Zhang J, Shi Q, Wang GZ, Wang F, Jiang N
Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
Abstract
INTRODUCTION: It was the aim of this study to compare the efficiency and safety between shock wave lithotripsy (SWL) and ureteroscopic holmium laser lithotripsy (URL) methods for ureteral calculi while also determining which option is more cost-effective.
PATIENTS AND METHODS: During January 2008 to September 2009, a prospective randomized study was conducted to compare both modalities for the management of solitary radiopaque ureteral stones. Patient and stone characteristics, treatment outcome and charges were documented. Both options were compared using univariate statistical tests to identify the efficiency quotient and cost-effectiveness for ureteral calculi according to the stone location.
RESULTS: A total of 257 patients were in the SWL group, while 269 were in the URL group. The efficiency quotients for SWL and URL were 0.81 and 0.88, respectively. The initial stone-free rate of URL for lower ureteral calculi was higher (p = 0.002), while the complication rate of SWL for upper ureteral calculi was lower (p = 0.027). The SWL group required lower hospitalization charges (USD 440 vs. 1,221; p < 0.001), lower total charges (USD 454 vs. 1,284; p < 0.001) and a shorter period of hospitalization (5.4 vs. 6.6 days; p < 0.001) compared with the URL group for all ureteral locations. For mid and lower ureteral calculi, the postoperative office visits of the URL group were fewer (1.03 vs. 1.1 times; p = 0.001).
CONCLUSIONS: Primary in situ SWL for upper and middle ureteral calculi showed lower complication rates compared to URL and was more cost-effective in Eastern China. However, primary URL was a better option for treating lower ureteral stones with a higher stone-free rate but was more expensive.
Copyright © 2011 S. Karger AG, Basel.
Urol Int. 2011;86(4):470-5. doi: 10.1159/000324479. Epub 2011 May 18
PMID: 21597268 [PubMed - in process]
Comments 1
This is a prospectively randomized study to compare SWL and URS for the management of solitary radiopaque ureteral stones. It is difficult to understand how randomization was done: “Patients were randomly categorized into the treatment group on the basis of the initial procedure used to treat their stone.”
In the text the authors state: “The purpose of this study was to determine which modality was more cost-effective.” And one of the conclusions is: “Primary in situ SWL for upper and middle ureteral calculi showed lower complication rates compared to URL and was more cost-effective in Eastern China”
This was compared to the results achieved in a similar study in the USA by Parker et al. (Reference 13 :Parker BD et al. Urology. 2004 Dec;64(6):1102-6 Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser.)
This comparison can be put into a table:
PROXIMAL URETERAL STONE TEATMENT
Parker et al. conclude:
“URS is more efficient and cost-effective for stones up to and larger than 1 cm with similar complication rates compared with ESWL.”
This shows how pointless it is to compare charges. US citizens could fly first class to China and still have money left over for stone treatment.
Peter Alken