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Initial Extracorporeal Shockwave Lithotripsy versus Ureteroscopy: A Re-treatment and Cost Analysis Using a
Parth M Patel1, Elizabeth Koehne1, Victor S Chen1
1Loyola University Medical Center, Department of Urology, Maywood, Illinois.
Urology Practice
|May 5, 2023
Summary
Shockwave lithotripsy has higher re-treatment rates than ureteroscopy, leading to increased costs. Ureteroscopy is a more cost-effective intervention for kidney stone treatment.
Area of Science:
- Urology
- Health Economics
- Medical Technology Assessment
Background:
- Kidney stone treatment effectiveness and cost are critical considerations.
- Comparing shockwave lithotripsy (SWL) and ureteroscopy (URS) is essential for optimizing patient care and resource allocation.
Purpose of the Study:
- To compare re-treatment rates between SWL and URS.
- To evaluate the cost-effectiveness of SWL versus URS for kidney stone management.
Main Methods:
- Retrospective analysis of the Florida State Ambulatory Surgery Database (2009-2015).
- Inclusion of 98,011 patients undergoing SWL or URS.
- Tracking of subsequent stone surgeries within 3 months, 6 months, and 1 year.
- Estimation of healthcare costs and multivariable logistic regression for predictor analysis.
Main Results:
- SWL had a 21.2% re-treatment rate within 3 months, compared to 10% for URS (p < 0.01).
- Patients undergoing SWL were over twice as likely to need a second procedure (OR 2.4).
- The 3-month cost was higher for SWL ($6,239) than URS ($5,319) (p < 0.01).
Conclusions:
- SWL is associated with significantly higher re-treatment rates than URS.
- URS represents a more cost-effective intervention for kidney stone treatment due to lower re-treatment needs.
- These findings support URS as a preferred modality for certain kidney stone presentations.
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