Cost-Effectiveness of Treating Ureteral Stones in a Taipei City Hospital: Shock Wave Lithotripsy versus Ureteroscopy plus Lithoclast

Abstract

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.

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

“…Although the patients do not need to pay for the laser fiber charges, the high costs of laser lithotripsy based on the number of pulses applied was responsible for the high treatment charges associated with URL when compared with the Western countries [14] . This also differed from other cities in Eastern Asia [15] . Further, it was associated with the charges of DJ stent fixation and later removal by secondary cystoscopy.…”

“…Moreover, URL treatment is cheaper than SWL outside mainland China [5,15,17] . Many patients have the desire to be stone free after the first session because access to health care might be too expensive for ancillary or repeat procedures in many countries [3] .…”

Value of focal applied energy quotient in treatment of ureteral lithiasis with shock waves

“…Huang carried out a cost/effectiveness study of 448 cases of ureteral lithiasis, 360 treated with ESWL and 88 with ureteroscopy and kinetic lithotripsy with lithoclast, and obtained a similar EQ for both groups, 0.62 in the group treated with ESWL and 0.65 in the group treated with lithoclast [11]. Cost of treatment was higher in the ESWL group; however, the rate of success was higher in the group treated with lithoclast, 89.8% versus 71.7%.…”

“…ESWL EQ ranges between 0.39 and 0.93 versus 0.52 in Holmium:YAG laser endoscopic lithotripsy and we think that efficiency for both procedures can be improved by limiting the use of DJ catheter or auxiliary maneuvers, especially in patients with mid and distal ureteral calculi treated with endoscopic laser lithotripsy, as recommended by Shao [19]. ESWL efficiency can be optimized if we apply more energy shock waves (mJ/ShW) but mainly with a better focalization of the calculus, being necessary to increase both the degree of analgesia-sedation and tolerance to treatment [9][10][11][12][13][14][15][16][17][18][19][20]; in this study we see a correlation between higher FAEQ and therapeutic success.…”

Economic Outcomes of Treatment for Ureteral and Renal Stones: A Systematic Literature Review

“…Five groups evaluated distal ureteral stones (Bierkens, 5 Chang, 6 Huang, 7 Lotan 8 and Wolf 9 et al), representing American, European and Asian studies. Three groups evaluated mid ureteral stones (Bierkens, 5 Huang 7 and Lotan 8 et al), representing American, European and Asian studies. Five groups evaluated proximal ureteral stones (Huang, 7 Lotan, 8 Izamin, 10 Parker 11 and Wu 12 et al), representing the U.S. and Asia.…”