title: Cost-effectiveness comparison of ureteral calculi treated with ureteroscopic laser lithotripsy versus shockwave lithotripsy.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of shockwave lithotripsy (SWL) versus ureteroscopic lithotripsy (URS) for patients with ureteral stones less than 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 ureteral stones under 1.5 cm 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 using our results and success rates for modeling. Three separate models were created to reflect differing practice patterns.
  
  
  RESULTS
  A total of 113 patients were included-51 underwent SWL and 62 underwent URS as primary treatment. Single procedure stone-free rates for SWL and URS were 47.1 and 88.7 %, respectively (p < 0.002). Decision analysis modeling demonstrated cost-effectiveness of SWL when SWL single procedure stone-free rates (SFR) were greater than or equal to 60-64 % or when URS single procedure SFRs were less than or equal to 57-76 %, depending on practice patterns.
  
  
  CONCLUSIONS
  This retrospective study revealed superior SFR for ureteral stones less than 1.5 cm treated with URS compared to SWL. Our decision analysis model demonstrated that when SFR for SWL is less than 60-64 % or is greater than 57-76 % for URS, 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.
authors.affiliation: Division of Urology, Duke University School of Medicine, Durham, NC, USA. eugene.cone@duke.edu.
authors.forename: Eugene B
authors.identifier: http://orcid.org/0000-0002-0292-7534
authors.initials: EB
authors.lastname: Cone
authors.affiliation: Division of Urology, Warren Alpert School of Medicine of Brown University, Providence, RI, USA.
authors.forename: Gyan
authors.initials: G
authors.lastname: Pareek
authors.affiliation: Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Ursiny
authors.affiliation: Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Eisner
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007391:International Cooperation; D008096:Lithotripsy / Q000191:economics; D017602:Lithotripsy, Laser / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy / Q000191:economics*
keywords: Cost-effective; Decision analysis; Shockwave lithotripsy; Ureteral calculi; Ureteroscopy