title: Estimating the nationwide, hospital based economic impact of pediatric urolithiasis.
abstract: OBJECTIVE
  The incidence of urolithiasis is increasing in children and adolescents but the economic impact of this problem is unclear. We examined 2 large databases to estimate the nationwide economic impact of pediatric urolithiasis.
  
  
  METHODS
  We analyzed the 2009 NEDS and KID, used ICD-9-CM codes to identify children 18 years or younger diagnosed with urolithiasis and abstracted demographic and charge data from each database.
  
  
  RESULTS
  We identified 7,348 weighted inpatient discharges in KID and 33,038 emergency department weighted encounters in NEDS. Of the patients 32% and 36% were male, respectively. Inpatients were younger than those who presented to the ED (mean age 13.9 vs 15.7 years). Most patients had private insurance (52.9% to 57.2%) and the South was the most common geographic region (39.5% to 44.4%). The most common procedures were ureteral stent placement in 20.4% to 24.1% of cases, followed by ureteroscopy in 3.8% to 4.4%. Median charges per admission were $13,922 for a weighted total of $229 million per year. Median emergency department charges were $3,991 per encounter for a weighted total of $146 million per year.
  
  
  CONCLUSIONS
  Each day in 2009 in the United States an estimated 20 children were hospitalized and 91 were treated in the emergency department for upper tract stones. A conservative estimate of 2009 annual charges related to pediatric urolithiasis in the United States is at least $375 million. This is likely a significant underestimate of the true economic burden of pediatric urolithiasis because it accounts for neither outpatient management nor indirect costs such as caregiver time away from work.
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Hsin-Hsiao S
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: John S
authors.initials: JS
authors.lastname: Wiener
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lipkin
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sherry S
authors.initials: SS
authors.lastname: Ross
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: jonathan.routh@duke.edu.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
mesh_terms: D000293:Adolescent; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D015607:Stents; D014481:United States / Q000453:epidemiology; D018666:Ureteroscopy; D052878:Urolithiasis / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy
keywords: costs and cost analysis; hospitalization; kidney; ureter; urolithiasis