Cost-effectiveness comparison of renal calculi treated with ureteroscopic laser lithotripsy versus shockwave lithotripsy.
OBJECTIVE
To evaluate the cost-effectiveness of shockwave lithotripsy (SWL) vs ureteroscopic lithotripsy (URS) for patients with renal stones <1.5 cm in diameter.


METHODS
Patient age, stone diameter, stone location, and stone-free status were recorded for patients treated with SWL or URS for renal stones <1.5 cm in maximal diameter over a 1-year period. Institutional charges were obtained from in-house billing. A decision analysis model was constructed to compare the cost-effectiveness of SWL and URS and using our results and success rates for modeling. Three separate models were created to reflect practice patterns for SWL.


RESULTS
One hundred fifty-eight patients were included in the study-78 underwent SWL and 80 underwent URS as primary treatment. Single procedure stone-free rates (SFR) for SWL and URS were 55% and 95%, respectively (P<0.0001). Decision analysis modeling demonstrated cost-effectiveness of SWL when SWL single procedure SFR were 65% to 67% or when URS single procedure SFR was 72% to 84%.


CONCLUSIONS
This retrospective study revealed superior SFR results for renal stones <1.5 cm for URS compared with SWL. Our decision analysis model demonstrates that for SWL SFR less than 65% to 67% or for URS SFR greater than 72% to 84%, SWL is not a cost-effective treatment option. Based on these findings, careful stratification and selection of stone patients may enable surgeons to increase the cost-effectiveness of SWL.
1 Division of Urology, Duke University Medical Center, Duke University School of Medicine , Durham, North Carolina.
Eugene B
EB
Cone
Brian H
BH
Eisner
Michal
M
Ursiny
Gyan
G
Pareek
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000191:economics* / Q000379:methods; D017602:Lithotripsy, Laser / Q000191:economics*; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000628:therapy; D018666:Ureteroscopy / Q000191:economics*