Cost-Effectiveness Analysis of Extracorporeal Shock Wave Lithotripsy Versus Retrograde Intrarenal Surgery In The Management of Small Moderated-Sized Renal Stones

• Published in: Value in health Vol. 20; no. 9; p. A490
• Main Authors: Caballer Tarazona, V, Budía Alba, A, Díez de Pablos, JA, Bahilo Mateu, P, Vivas-Consuelo, D
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01-10-2017
• Subjects: Anesthesia; Calculi; Cost analysis; Dominance; Extracorporeal shockwave lithotripsy; Health care expenditures; Hospitalization; Implants; Kidney diseases; Kidney stones; Kidneys; Lithiasis; Medical personnel; Medical treatment; Monte Carlo simulation; Operating rooms; Patients; Sedation; Simulation; Stone; Surgery; Ureter
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.516

OBJECTIVES: To compare the safety and cost-effectiveness of retrograde intrarenal surgery with Holmium:YAG laser (RIRS) vs extracorporeal Shockwave Lithotripsy (SWL) in the treatment of small-moderated renal stones. METHODS: 345 patients who were diagnosed and treated for small-moderated-sized renal stones (< 20 mm) between June 2012 and December 2014, participated in a prospective study. 201 patients (52,26%) were in SWL group and 144 patients (41,74%) were in RIRS group. SWL was performed under mild sedation with pethidine hydrochloride for a maximum of 4 sessions, and RIRS was performed with flexible ureterorenoscope (Flex-X2 Storz) and intracorporeal Holmium:YAG laser (Stone light-AMS) lithotripsy under general anesthesia. The safety and effectiveness of both treatments were assessed and calculated. The direct cost analysis included costs of: hospitalization, operating theatre and lithotripter procedure, health staff, materials and re-treatments for each procedure applied. RESULTS: Both groups were comparable in terms of side, size, composition of the stone and need for a previous double J ureteric stent. The global stone-free rate for renal ureteroscopy was 91,72% and 79,25% for SWL. In patients with stones <lcm, the RIRS was significantly better than the SWL with stone-free rates of 91,14% and 83,13% respectively. For stones >1 cm there were also differences: 92,31% stone-free rate in the URS group and 75,2% in the SWL group. The overall complication rate was significantly higher in SWL group (28,95%) as compared to the RIRS group (7,8%). The average cost of the SWL group was 1.069,53 euros, while in the RIRS group it was 2.841,06 euros. The estimated ICER showed that SWL was more cost-effectiveness than RIRS. After performing the Monte Carlo simulation, the dominance of SWL prevalied regardless of the size of stone. CONCLUSIONS: The results of this study indicate that SWL was more cost-effective than RIRS for the treatment of small-moderated sized renal stones.