title: Cost-effectiveness of anti-retropulsion devices for ureteroscopic lithotripsy.
abstract: OBJECTIVE
  We evaluated the cost-effectiveness of anti-retropulsion devices used during ureteroscopic lithotripsy.
  
  
  METHODS
  A decision analysis model was constructed to compare the cost-effectiveness of ureteroscopic lithotripsy with vs without an anti-retropulsion device. The risk of stone retropulsion was determined from published data in the English language literature. Expected value calculations were used to determine whether the additional cost of a device would be cost-effective to prevent secondary procedures used to treat retropulsed stones. Device cost was determined using the average cost of all commercially available devices.
  
  
  RESULTS
  It became cost-effective to use an anti-retropulsion device at or above a 6.3% retropulsion rate. The weighted probability of retropulsion with vs without an anti-retropulsion device was 98.1% vs 83.7%. The estimated costs of secondary procedures needed to treat retropulsed stones were $5,290 for shock wave lithotripsy and $6,390 for ureteroscopy. Average device cost was $278. Thus, the average additional cost of ureteroscopic lithotripsy with vs without an anti-migration device would be $384 vs $952.
  
  
  CONCLUSIONS
  It is cost-effective to use an anti-retropulsion device at a retropulsion rate of greater than 6.3%.
authors.affiliation: Kidney Stone Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Ursiny
authors.forename: Brian H
authors.initials: BH
authors.lastname: Eisner
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004867:Equipment Design; D006801:Humans; D008096:Lithotripsy / Q000191:economics* / Q000295:instrumentation*; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy / Q000191:economics*