Cost-Effectiveness Comparison of Renal Calculi Treated with Ureteroscopic Laser Lithotripsy Versus Shockwave Lithotripsy

Cone, Eugene B.; Eisner, Brian H.; Ursiny, Michal; Pareek, Gyan

doi:10.1089/end.2013.0669

Cited by 30 publications

(23 citation statements)

References 11 publications

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“…Unlike other studies, we used our real terms of effectiveness, allowing us in daily practice to make informed decisions based on terms of cost-effectiveness of our own environment. Although we are agree with Cone et al [22] that clinical decisions should not be based only in terms of costs. At least we should analyze the total cost of each technique before decide one treatment option.…”

Section: Citationsupporting

confidence: 88%

Comparison of Extracorporeal Shock Wave Lithotripsy versus Ureteroscopy Holmium Laser Lithotripsy in the Management of Ureteral Stones: A Cost-effectiveness Analysis

Alba¹,

Caballer²

2016

Med Surg Urol

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Objective: To determine the better cost-effective treatment strategy for ureteral stones in a health district of Eastern Spain.Methods: A total of 180 patients were treated between June 2012 and December 2013 for ureteral stones using two different strategies (SWL as initial treatment and URS as rescue technique vs URS and laser lithotripsy (up to 2 procedures). We performed an economic evaluation through a cost effectiveness analysis comparing costs and outcome. We performed a differentiating model in patients with lithiasis less than 1 cm or equal to or larger than 1 cm. The effectiveness parameter was the stone free rate (SFR), defined as the absence of lithiasis fragments or the presence of clinically insignificant residual fragments (CIRFs) -less than 3 mm at the 3 month follow up. A decision tree was developed and a Monte Carlo simulation was performed to establish uncertainty. Results:The SWL as first line was equally or more effective and cheaper than URS as first line of treatment for ureteral stones regardless of location or size. The overall cost for SWL (plus URS as second line) was 1,445,86 € and its SFR was 99.7%, and 2,369,21 and 97.62% for URS group. After the Montecarlo sensitivity analysis, the SWL showed dominance or cost-effectiveness in the vast majority of times, for each position and size.Conclusions: SWL as first line of treatment was more efficient in terms of cost effectiveness than first line URS with Ho: YAG laser lithotripsy for ureteral stones. Given its level of stone clearance, a non-invasive, outpatient based treatment like lithotripsy should remain the first-line treatment option for ureteral stones.

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Section: Citationsupporting

confidence: 88%

Comparison of Extracorporeal Shock Wave Lithotripsy versus Ureteroscopy Holmium Laser Lithotripsy in the Management of Ureteral Stones: A Cost-effectiveness Analysis

Alba¹,

Caballer²

2016

Med Surg Urol

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“…There have been few original studies examining the cost-effectiveness of URS in relation to SWL in the USA, and fewer still report both stone-free rate and cost/charge data (the two relevant cost-effectiveness outcomes for a stone treatment modality). Of those that we identified from 1995 to 2012, three were literature reviews [4][5][6], one was limited to proximal ureteral stones [7], and one was limited to renal stones [8]. Fig.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness comparison of ureteral calculi treated with ureteroscopic laser lithotripsy versus shockwave lithotripsy

et al. 2016

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This retrospective study revealed superior SFR for ureteral stones less than 1.5 cm treated with URS compared to SWL. Our decision analysis model demonstrated that when SFR for SWL is less than 60-64 % or is greater than 57-76 % for URS, SWL is not a cost-effective treatment option. Based on these findings, careful stratification and selection of stone patients may enable surgeons to increase the cost-effectiveness of SWL.

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“…The review investigation in Ref. [6] concluded better stone-free rates (SFRs) for renal stones <15 mm for URS compared with SWL. Even though laser lithotripsy has become the most popular treatment choice for kidney stone disease, the mechanism of calculus disintegration by laser pulse remains unclear.…”

Section: Cavitation Bubble Dynamicsmentioning

confidence: 99%

“…The review investigation in Ref. [6] concluded better stone-free rates for renal stones <15 mm for URS compared with SWL. However, the delivery fiber employed in URS encountered distal-end burn-back [20][21][22][23].…”

Section: Fiber-tip Damage Mechanismmentioning

confidence: 99%

Investigation of Laser Pulse‐induced Calculus Damage Mechanism by a High‐speed Camera

Zhang¹,

Xuan²,

Hasenberg³

2017

Updates and Advances in Nephrolithiasis - Pathophysiology, Genetics, and Treatment Modalities

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Even though laser lithotripsy has become the most popular treatment choice for kidney stone disease, the mechanism calculus disintegration by laser pulse remains unclear. This is due to the multiple physical/chemical processes involved in laser pulse-caused calculus damage and their sub-microsecond timescales. A high-speed camera with a frame rate up to 1 million frames per second (fps) was employed in this study. The results revealed the cavitation bubble dynamics (oscillation and center of bubble movement) by Ho-and Tm-laser pulses at a different energy level and pulse width. Besides, fiber-tip degradation, damage, or burn-back is a common problem during the ureteroscopic laser lithotripsy procedure to treat urolithiasis. The results suggested that using a high-speed camera and the Schlieren method to visualize the shock wave provided valuable information about time-dependent acoustic energy propagation and its interaction with cavitation, the fiber tip, and calculus. And lastly, calculus migration is a common problem during ureteroscopic laser lithotripsy procedure to treat urolithiasis. In this investigation, calculus retropulsion was studied using a suspended pendulum in water to get rid of the friction. The results suggested that using the pendulum model to eliminate the friction improved sensitivity and repeatability of the experiment.

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Cost-Effectiveness Comparison of Renal Calculi Treated with Ureteroscopic Laser Lithotripsy Versus Shockwave Lithotripsy

Cited by 30 publications

References 11 publications

Comparison of Extracorporeal Shock Wave Lithotripsy versus Ureteroscopy Holmium Laser Lithotripsy in the Management of Ureteral Stones: A Cost-effectiveness Analysis

Comparison of Extracorporeal Shock Wave Lithotripsy versus Ureteroscopy Holmium Laser Lithotripsy in the Management of Ureteral Stones: A Cost-effectiveness Analysis

Cost-effectiveness comparison of ureteral calculi treated with ureteroscopic laser lithotripsy versus shockwave lithotripsy

Investigation of Laser Pulse‐induced Calculus Damage Mechanism by a High‐speed Camera

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