title: Decision analysis for economic evaluation of the management of chronic obstructive uropathy.
abstract: OBJECTIVE
  To test which is the best treatment for chronic obstructive uropathy: urinary diversion using a conventional double-J ureteral stent or  the metal thermo-expandable MemokathTM 051 prosthesis.
  
  
  METHODS
  We collected cost data of the insertion of a double-J stent taking into account preoperative and postoperative visits and surgery.  Structural, medical, consumables and the prosthesis costs were considered. The estimated survival of the patient, number of spare stents and cost of each  therapeutic measure were computed. Then, a simulation of the cost of inserting a MemokathTM 051 prosthesis was conducted, based on data of ureteral catheterization. We performed a decision tree and Cost Effectiveness economic analysis to measure the effectiveness of both health interventions.
  
  
  RESULTS
  Cost data of each procedure were: 1275.44 € for the double J catheter in a program of day case surgery (DCS), 4865.16 € for  the metal  thermo-expandable prosthesis as DCS, and 1424.52€for the double J stent with 1 day admission and 5014.24 € for the prosthesis with 1  day admission. The cost difference between ureteral stent and metal thermo-expandable prosthesis is 3589.72 € per treatment for the ureteral stent as DCS.
  
  
  CONCLUSIONS
  Despite its high initial cost, the metal thermo-expandable prosthesis potentially offers economic advantages over the  conventional double-J ureteral stent in the treatment of long evolution ureteral obstruction. After the third change of double-J stent, and  if the patient survival is long enough, the metal prosthesis as DCS should be the most cost effective option.
authors.affiliation: Urology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain. luis.llanes@yahoo.es
authors.forename: Luis Llanes
authors.initials: LL
authors.lastname: González
authors.forename: Álvaro Páez
authors.initials: ÁP
authors.lastname: Borda
authors.forename: Enrique Redondo
authors.initials: ER
authors.lastname: González
authors.forename: Javier Sáenz
authors.initials: JS
authors.lastname: Medina
authors.forename: Luis Crespo
authors.initials: LC
authors.lastname: Martínez
authors.forename: Rommel Oswaldo Alarcón
authors.initials: RO
authors.lastname: Parra
mesh_terms: D002908:Chronic Disease; D003661:Decision Support Techniques; D003663:Decision Trees; D006801:Humans; D019736:Prostheses and Implants; D015607:Stents / Q000191:economics*; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000191:economics* / Q000601:surgery*; D014547:Urinary Diversion / Q000191:economics*