Aim: To compare cost-effectiveness, success rates and sat isfaction score of ureteroscopic lithotripsy with lithoclast (URSL) and extracorporeal shock wave lithotripsy (ESWL) for ureteral stones in a Taipei City Hospital. Methods: This is a retrospective study. From July 1998 to June 2000, 448 patients who underwent treatment for ureteral stones were included. The patients were divided into two treatment groups according to the initial method adopted for the management of their stone. Medical records and hospital financial records were collected for costs of implementing each treatment program. The satisfaction scores of patients (rating from 0 to 10) were collected by telephone interviews. Success was defined as complete clearance of the stone or fragmentation of stones smaller than 2 mm by plain abdominal film and complete relief of symptoms after initial treatment. Results: A total of 360 patients were in the ESWL group (including 144 upper, 48 middle and 168 lower third stones) and 88 in the URSL group (including 28 upper, 24 middle and 36 lower third stones). The range of stone size was from 0.6 to 1.9 cm. The overall treatment cost was comparable in both groups with a trend for it to be higher in the ESWL group without reaching statistical significance (TWD 20,901.5 ± 8,911.3 vs. 19,876.1 ± 4,782.2). Stratified by the location of stone, the overall treatment cost was significantly higher in the ESWL group than in the URSL group for patients with upper third ureteral stones irrespective of stone size. The efficiency quotient for ESWL and URSL was 0.62 and 0.65, respectively. The success rate was significantly higher in the URSL group than in the ESWL group (89.8 vs. 71.7%). Satisfaction scores were similar for both groups with a trend to be higher in the ESWL group without reaching statistical significance (7.97 ± 1.01 vs. 7.53 ± 1.37). Conclusions: The overall treatment cost of patients with upper third ureteral stone was significantly higher in the ESWL group than in the URSL group, but the success rate was significantly higher in the URSL group than in the ESWL group.

To compare two different running models including self-support and outsourcing cooperation for the extracorporeal shock wave lithotripsy (SWL) machine in Taipei City Hospital, we made a retrospective study. Self-support means that the hospital has to buy an SWL machine and get all the payment from SWL. In outsourcing cooperation, the cooperative company provides an SWL machine and shares the payment with the hospital. Between January 2002 and December 2006, we used self-support for the SWL machine, and from January 2007 to December 2008, we used outsourcing cooperation. We used the method of full costing to calculate the cost of SWL, and the break-even point was the lowest number of treatment sessions of SWL to make balance of payments every month. Quality parameters including stone-free rate, retreatment rate, additional procedures and complication rate were evaluated. When outsourcing cooperation was used, there were significantly more treatment sessions of SWL every month than when utilizing self-support (36.3 +/- 5.1 vs. 48.1 +/- 8.4, P = 0.03). The cost of SWL for every treatment session was significantly higher using self-support than with outsourcing cooperation (25027.5 +/- 1789.8 NT$ vs. 21367.4 +/- 201.0 NT$). The break-even point was 28.3 (treatment sessions) for self-support, and 28.4 for outsourcing cooperation, when the hospital got 40% of the payment, which would decrease if the percentage increased. No significant differences were noticed for stone-free rate, retreatment rate, additional procedures and complication rate of SWL between the two running models. Besides, outsourcing cooperation had lower cost (every treatment session), but a greater number of treatment sessions of SWL every month than self-support.