title: Comparison of cost of care for tethered versus non-tethered ureteric stents in the management of uncomplicated upper urinary tract stones.
abstract: BACKGROUND
  Many surgeons use a stent after ureteroscopic lithotripsy (URSL). For short-term stenting purposes, a surgeon has the choice of either a tethered or a non-tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL.
  
  
  METHODS
  We retrospectively reviewed medical records for patients who underwent URSL for uncomplicated urolithiasis between January 2013 and December 2013 at two tertiary referral hospitals. Costs data was sourced from the costing department with complete data available for 134 patients. The overall medical care cost was estimated by computing the cost of surgery, stent-related emergency department presentations, re-admissions and stent removal.
  
  
  RESULTS
  A total of 113 patients had tethered stents and 21 had non-tethered stents, with similar age and gender composition between the two groups and complications rates. The mean cost of URSL and stent placement was A$3071.7 ± A$906.8 versus A$3423.8 ± A$808.4 (P = 0.049), mean cost of managing complications was A$309.4 ± A$1744.8 versus A$31.3 ± A$98.9 (P = 0.096), mean cost of out-patient clinic stent removal was A$222.5 ± A$60 versus A$1013.6 ± A$75.4 (P < 0.001) for endoscopic stent removal, overall mean cost of care was A$3603.6 ± A$1896.7 versus A$4468.1 ± A$820.8 (P = 0.042) for tethered and non-tethered stents, respectively.
  
  
  CONCLUSIONS
  It is cheaper to use a tethered ureteric stent compared with non-tethered stents for short-term stenting after uncomplicated URSL, with a mean cost saving of A$864.5.
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Alfin
authors.identifier: http://orcid.org/0000-0002-8918-7638
authors.initials: A
authors.lastname: Okullo
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Yuigi
authors.initials: Y
authors.lastname: Yuminaga
authors.affiliation: Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Ziaziaris
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ende
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.|School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Howard
authors.initials: H
authors.lastname: Lau
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brooks
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Manish I
authors.initials: MI
authors.lastname: Patel
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Bariol
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D014513:Ureter / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods; D014545:Urinary Calculi / Q000601:surgery*; D052878:Urolithiasis / Q000601:surgery*
keywords: non-tethered stent; tethered stent; ureteric stent; urolithiasis