Cost-Effectiveness Analysis of Ureteroscopic Laser Lithotripsy and Shock Wave Lithotripsy in the Management of Ureteral Calculi in Eastern China

Abstract

Introduction: It was the aim of this study to compare the efficiency and safety between shock wave lithotripsy (SWL) and ureteroscopic holmium laser lithotripsy (URL) methods for ureteral calculi while also determining which option is more cost-effective. Patients and Methods: During January 2008 to September 2009, a prospective randomized study was conducted to compare both modalities for the management of solitary radiopaque ureteral stones. Patient and stone characteristics, treatment outcome and charges were documented. Both options were compared using univariate statistical tests to identify the efficiency quotient and cost-effectiveness for ureteral calculi according to the stone location. Results: A total of 257 patients were in the SWL group, while 269 were in the URL group. The efficiency quotients for SWL and URL were 0.81 and 0.88, respectively. The initial stone-free rate of URL for lower ureteral calculi was higher (p = 0.002), while the complication rate of SWL for upper ureteral calculi was lower (p = 0.027). The SWL group required lower hospitalization charges (USD 440 vs. 1,221; p < 0.001), lower total charges (USD 454 vs. 1,284; p < 0.001) and a shorter period of hospitalization (5.4 vs. 6.6 days; p < 0.001) compared with the URL group for all ureteral locations. For mid and lower ureteral calculi, the postoperative office visits of the URL group were fewer (1.03 vs. 1.1 times; p = 0.001). Conclusions: Primary in situ SWL for upper and middle ureteral calculi showed lower complication rates compared to URL and was more cost-effective in Eastern China. However, primary URL was a better option for treating lower ureteral stones with a higher stone-free rate but was more expensive.

What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review

“…A total of 47 studies were eligible for final inclusion; 22 of these compared URS with SWL. Of these, 18 were full text articles [5,9,11,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and four were conference abstracts [35][36][37][38].…”

“…Length of stay was reported in four studies; two RCTs [11,21] and two NRSs [9,28]. In all four studies, the mean length of hospital stay was greater for patients undergoing URS compared with SWL and in two of the four studies [11,21] a p-value was provided, and in both cases, reached statistical significance.…”

“…Of the 22 final studies comparing SWL with URS, four were RCTs [11,20,21,35], one was a QRCT [22] and 17 [5,9,[23][24][25][26][27][28][29][30][31][32][33][34][36][37][38] were comparative NRSs. Of the final 25 included comparative intragroup (intra-SWL and intra-URS) studies, 24 were full text articles [7,, and one was a conference abstract [62].…”

“…''Stonefree'' was defined for the purposes of this review as no stone fragments remaining at the reported time point. Stone-free status was measured immediately in four studies [11,29,31,33], at 1 wk in one study [20], at 2 wk in two studies [21,22], at 3 wk in one study [9], at 4 wk in four studies [24,25,30,32], at 6 wk in one study [27], at 3 mo in six studies [5,9,24,28,30,35], and was unclear in six studies [23,26,34,[36][37][38]. In three of the studies two different SFR time points were measured within each study [9,24,30].…”

“…1, achievement of stone-free status favouring URS reached statistical significance in nine studies [22,24,25,[29][30][31][32][33]36] of which four were significant at 4 wk [24,25,30,32]. In the remaining 13 studies [5,9,11,20,21,23,[26][27][28]34,35,37,38] no significant difference was found between SWL and URS for the treatment of proximal ureteric stones. There was significant heterogeneity in the lithotripter devices used, their power settings, the modalities used for SFR assessment, and the number of shock waves delivered among those patients treated with SWL.…”