Analysis of Cost Variation in Endourological Procedures throughout the United States Using a National Database

We examined geographic variations in the direct costs of endourological procedures, including percutaneous nephrolithotomy, shock wave lithotripsy and retrograde intrarenal surgery/ureteroscopy, as well as the impact of hospital factors on costs using Vizient™, a national clinical database.

We performed statistical analysis on 44,379 cases (percutaneous nephrolithotomy in 8,395, shock wave lithotripsy in 12,979 and retrograde intrarenal surgery/ureteroscopy in 23,005) from 2015 to 2018 augmented with information from the 2017 American Hospital Directory to determine the impact of hospital factors on the direct costs of endourological procedures across American Urological Association geographic sections.

We found a mean±SD direct cost of $5,040±$1,578 for percutaneous nephrolithotomy, $1,994±$642 for shock wave lithotripsy and $2,291±$1,077 for retrograde intrarenal surgery/ureteroscopy nationally. The South Central region had the highest costs for shock wave lithotripsy (mean±SD $3,022±$815), while the Western region had the highest costs for percutaneous nephrolithotomy and retrograde intrarenal surgery/ureteroscopy ($5,610±$1,460 and $3,207±$1,338, respectively). The Northeastern region had the lowest mean±SD costs for percutaneous nephrolithotomy ($4,368±$1,613), shock wave lithotripsy ($927±$234) and retrograde intrarenal surgery/ureteroscopy ($1,824±$1,238). For percutaneous nephrolithotomy and retrograde intrarenal surgery/ureteroscopy high volume institutions had greater costs compared to low volume institutions ($5,318 vs $5,092, p <0.01 and $2,579 vs $2,246, p <0.01, respectively). This finding was not replicated for shock wave lithotripsy ($2,096 vs $2,119, p=0.9).

Significant geographic variation exists regarding direct costs of endourological procedures, with higher volume hospital systems having greater costs for percutaneous nephrolithotomy and retrograde intrarenal surgery/ureteroscopy regardless of location.