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Simultaneous Bilateral Percutaneous Nephrolithotomy: Is It Cost-Effective?

Gillian Murray1, Austen Slade2, Ben Johnson2

  • 1Mayo Clinic Rochester, Department of Urology, Rochester, MN.

Urology
|February 27, 2025
PubMed
Summary
This summary is machine-generated.

Simultaneous bilateral percutaneous nephrolithotomy (PCNL) is more cost-effective and effective than staged PCNL for large bilateral kidney stones. This approach offers better outcomes at a lower cost within one year.

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Area of Science:

  • Urology
  • Health Economics
  • Nephrolithiasis Management

Background:

  • Large bilateral kidney stones present complex treatment challenges.
  • Percutaneous nephrolithotomy (PCNL) is a primary treatment modality.
  • Comparing simultaneous vs. staged approaches is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

  • To evaluate the cost-effectiveness of simultaneous versus staged PCNL for patients with large, bilateral kidney stone burdens.
  • To compare clinical outcomes, including stone-free rates and quality-adjusted life years (QALYs).

Main Methods:

  • A decision-analytic Markov model was employed to simulate costs and outcomes.
  • Data on procedure costs, operative time, and length of stay were sourced from a large, single-center cohort.
  • Medicare costs and QALYs were primary outcome measures, with a willingness-to-pay threshold of $100,000/QALY.

Main Results:

  • Simultaneous PCNL incurred lower costs ($52,585) compared to staged PCNL ($61,687) at one year.
  • Simultaneous PCNL yielded higher QALYs (0.982) than staged PCNL (0.977).
  • Staged PCNL was only cost-effective under specific conditions, such as an 88% stone-free rate or a significant reduction in unilateral PCNL costs.

Conclusions:

  • Simultaneous bilateral PCNL is demonstrated to be less costly and more effective than staged bilateral PCNL within one year.
  • This finding holds even with assumptions of slightly reduced stone-free rates and increased complication rates for the simultaneous approach.
  • The results support the use of simultaneous bilateral PCNL in appropriate clinical scenarios for managing large, bilateral kidney stones.