title: Clinical and economic impact of implementation of slow shockwave lithotripsy for the treatment of urinary calculi.
abstract: OBJECTIVE
  To analyze the impact of slowing the shockwave delivery during extracorporeal shockwave lithotripsy (SWL) on the clinical patient outcome and the cost of delivering this service in a community practice.
  
  
  METHODS
  The data from 1745 consecutive SWL procedures were analyzed at a freestanding surgery center. About 872 treatments were performed at 120 shocks per minute (fast rate [FR]) and 873 were performed at 60 shocks per minute (slow rate [SR]) using a Lithotron machine. Ninety-nine percent of the patients received 3000 shocks. The location and stone size were similar in both groups. Stone-free rate was determined by a plain film of the abdomen at follow-up.
  
  
  RESULTS
  The clinical outcome of SR shows a statistically significant improvement in stone-free rate on all stone locations and stone sizes except for those smaller than 25 mm(2). The need for additional secondary treatment decreased from 35.4% to 18.2%. The anesthesia time increased from 26 to 50 minutes per treatment. On the basis of Medicare reimbursement, there was an increase of $28,294 for anesthesia services by going SR. However, the savings realized as a result of decrease in secondary procedures was $264,989, resulting in a total savings of $236,695 during the study period. The cost savings was $271.13 per SWL treatment.
  
  
  CONCLUSIONS
  The slowing of SWL treatment results in a longer procedure decreasing the time available for treatment; however, the clinical outcome results in improved patient quality of care and decreased cost. Slowing SWL both benefits the patient and decreases the cost of SWL in the community setting.
authors.affiliation: Virginia Urology, Richmond, Virginia 23235, USA. ekramolowsky@uro.com
authors.forename: Eugene V
authors.initials: EV
authors.lastname: Kramolowsky
authors.forename: Grace
authors.initials: G
authors.lastname: Wang
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Butler
authors.forename: Nada L
authors.initials: NL
authors.lastname: Wood
mesh_terms: D006801:Humans; D007349:Insurance, Health, Reimbursement; D008096:Lithotripsy / Q000191:economics* / Q000379:methods*; D006278:Medicare; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014545:Urinary Calculi / Q000191:economics* / Q000628:therapy*