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Cost-effectiveness study of the extracorporeal shock-wave lithotriptor
E E Hatziandreu1, K Carlson, A G Mulley
1Harvard School of Public Health.
International Journal of Technology Assessment in Health Care
|January 1, 1990
Summary
Extracorporeal shock-wave lithotripsy (ESWL) is preferred for smaller urinary stones, while percutaneous ultrasonic lithotripsy (PUL) is better for larger ones. Both methods are more cost-effective than surgery.
Area of Science:
- Urology
- Health Economics
Background:
- Upper urinary tract stones pose a significant clinical challenge.
- Multiple treatment modalities exist, including percutaneous ultrasonic lithotripsy (PUL), extracorporeal shock-wave lithotripsy (ESWL), and surgery.
- Understanding the cost-effectiveness of these treatments is crucial for clinical decision-making.
Purpose of the Study:
- To compare the relative efficacy and costs of PUL, ESWL, and surgery for upper urinary tract stones.
- To identify the most cost-effective treatment strategy based on stone size.
Main Methods:
- A cost-effectiveness analysis was conducted using a Markov model.
- The model incorporated 35 states, 3-month cycles, and a 5-year time frame.
- Probability estimates were derived from a meta-analysis of published literature.
Main Results:
- For stones ≤ 2 cm, ESWL is preferred, saving $440 and reducing morbidity by 2 days compared to PUL.
- For larger stones, PUL is preferred, saving $722 and reducing morbidity by 4 days compared to ESWL.
- Both ESWL and PUL demonstrated superior cost-effectiveness compared to surgery.
Conclusions:
- ESWL is generally preferred for upper urinary tract stones, but PUL becomes more favorable for larger stones.
- Treatment decisions should consider stone size, efficacy rates, recurrence, and specific costs.
- Further research is needed to refine data on efficacy and costs for optimal treatment selection.