Cost-effectiveness and efficiency of shockwave lithotripsy vs flexible ureteroscopic holmium:yttrium-aluminium-garnet laser lithotripsy in the treatment of lower pole renal calculi

Abstract

What's known on the subject? and What does the study add? Stone management economics is a complex issue. FURS and SWL are recognised treatment option for lower pole kidney stones. There are paucity of data comparing cost implication and effectiveness of both treatment options. Both treatment modalities are equally efficacious. FURS incurred greater cost burden compared to SWL in the UK setting. In the present economic circumstance, clinicians should also consider cost-impact, patient's preference and specific clinical indication when counselling patients for treatment.

Objective: • To compare the cost-effectiveness and outcome efficiency of extracorporeal shockwave lithotripsy (SWL) vs intracorporeal flexible ureteroscopic laser lithotripsy (FURS) for lower pole renal calculi ≤20 mm.

Patients and methods: • Patients who had treatment for their radio-opaque lower pole renal calculi were categorized into SWL and FURS group. • The primary outcomes compared were: clinical success, stone-free, retreatment and additional procedure rate, and perceived and actual costs. • Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <3 mm. • Perceived cost was defined as the cost of procedure alone, and the actual cost included the cost of additional procedures as well as the overhead costs to result in clinical success.

Results: • The FURS (n= 37) and SWL (n= 51) group were comparable with respect to sex, age, stone size and the presence of ureteric stent. • The final treatment success rate (100% vs 100%), stone-free rate (64.9% vs 58.8%), retreatment rate (16.2% vs 21.6%) and auxillary procedure rate (21.6% vs 7.8%) did not differ significantly. • The mean perceived cost of each FURS and SWL procedure was similar (£249 vs £292, respectively); however, when all other costs were considered, the FURS group was significantly more costly (£2602 vs £426, P= 0.000; Mann-Whitney U-test).

Conclusion: • SWL was efficacious and cost-effective for the treatment of lower pole renal calculi ≤20 mm.