Economic outcomes of treatment for ureteral and renal stones: a systematic literature review.
OBJECTIVE
We evaluated the cost-effectiveness of ureteral/renal stone treatment by comparing ureteroscopy, extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.


METHODS
We performed a systematic literature search to identify studies of treatment for adults with ureteral and renal stones that were published between 1995 and 2010. For inclusion in analysis studies had to provide the stone-free rate and the cost of at least 2 therapies.


RESULTS
Ten studies were identified, including 8 with an observational design and 2 that synthesized data using decision modeling techniques. Five of 6 studies, including 1 of 2 from the United States, compared ureteroscopy vs shock wave lithotripsy for proximal stones and showed a higher stone-free rate and lower cost for ureteroscopy. Four of the 5 studies, including the only American study, compared ureteroscopy vs shock wave lithotripsy for distal ureteral stones and also showed such an economically dominant result. Studies of shock wave lithotripsy vs percutaneous nephrolithotomy and ureteroscopy vs percutaneous nephrolithotomy for renal stones demonstrated higher cost and a higher stone-free rate for percutaneous nephrolithotomy.


CONCLUSIONS
Despite the great heterogeneity and limited quality of available cost-effectiveness evaluations most studies demonstrated that ureteroscopy was more favorable than shock wave lithotripsy for ureteral stones in stone-free rate and cost.
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. bmatlaga@jhmi.edu
Brian R
BR
Matlaga
Jeroen P
JP
Jansen
Lisa M
LM
Meckley
Thomas W
TW
Byrne
James E
JE
Lingeman
D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000191:economics* / Q000628:therapy*; D008096:Lithotripsy / Q000191:economics*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000191:economics*; D012008:Recurrence; D014481:United States; D014514:Ureteral Calculi / Q000191:economics* / Q000628:therapy*; D018666:Ureteroscopy / Q000191:economics*