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Cost Effectiveness Comparison of Renal Calculi Treated with Ureteroscopy with Laser Lithotripsy Versus Shock Wave Lithotripsy
Eugene B. Cone, MD1, Brian H. Eisner, MD2, Michal Ursiny, BA2, Gyan Pareek, MD1.
1Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
BACKGROUND: We evaluated the cost effectiveness of ureteroscopy plus holmium:YAG laser versus extracorporeal shock wave lithotripsy for patients with ureteral or renal stones less than 1.5cm in diameter.
METHODS: Patient age, stone diameter, stone location, and stone free status were recorded for patients treated with ureteroscopy with laser lithotripsy (URS) or shock wave lithotripsy (SWL) for renal stones under 1.5cm over a one year period at Rhode Island Hospital or The Miriam Hospital. Institutional charges were obtained from in-house billing. Chi-square statistics were calculated for categorical variables with Fischer’s exact test used to calculate P value, with continuous variables being tested with student’s T and ANOVA with post-test confirmation of significance via Neuman Keuls. A decision analysis model was constructed to compare the cost-effectiveness of SWL and ureteroscopy and using our results and success rates for modeling. Three separate models were created to reflect practice patterns for shock wave lithotripsy.
RESULTS: Patients treated with SWL (n=78) and URS (n=93) had respective mean ages of 54 and 53 (p >0.05), mean stone diameters of 7mm and 7.27mm (p>0.05). SFR for SWL and URS were 55% (43) and 95% (76) (p<0.0001). SWL patients with remaining stone were treated with auxiliary URS (5) and SWL (5). Average charges per SWL were $3,167 versus $4,470 (p<0.001) but after factoring auxiliary procedures the charges per stone free patient were $5,514 versus $4,975 (p<0.001). When considering cost-effectiveness based on decision analysis modeling, SWL success rates must be 65-67% or URS success rates must be 72-84% for SWL to be a cost-effective treatment choice.
CONCLUSIONS: Our retrospective study revealed superior SFR results for renal stones under 1.5cm for URS compared to SWL. Our decision analysis model demonstrates that SWL is effective if success rates are 65-67% or if URS success rates are 72-84%. Based on these findings, careful stratification and selection of stone patients may enable surgeons to increase the cost effectiveness of SWL treatments with proper patient selection.
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