Health Care Spending Associated With Preventative Pharmacologic Therapy for Urolithiasis

Area of Science:

• Urology
• Health Economics
• Pharmacology

Background:

• Urolithiasis (kidney stones) poses a significant financial burden on healthcare payers.
• Preventative pharmacologic therapy (PPT) aims to reduce symptomatic stone recurrences.
• The cost-effectiveness of PPT, considering medication expenses versus recurrence savings, requires careful evaluation.

Purpose of the Study:

• To assess the payer perspective cost of preventative pharmacologic therapy for urolithiasis.
• To compare the costs associated with adherence, non-adherence, and lack of PPT among patients with urinary chemistry abnormalities.

Main Methods:

• Utilized the Medicare-Litholink database for beneficiaries with urolithiasis and urinary chemistry abnormalities.
• Measured payments and out-of-pocket costs for patients prescribed PPT (adherent and non-adherent) versus untreated patients.
• Employed 2-part generalized linear models for payment comparisons across patient groups.

Main Results:

• Alkali therapy constituted the largest portion (42.7%) of spending among adherent patients, with out-of-pocket costs for alkali representing 88% of total prescription expenses.
• For patients with hypocitraturia or low urine pH, adherence to PPT led to fewer symptomatic stone events but higher overall costs due to medication.
• In cases of hypercalciuria and hyperuricosuria, nonadherent patients incurred the highest overall costs, even after adjustments.

Conclusions:

• Adherence to PPT is critical for realizing cost savings, particularly in managing hypercalciuria and hyperuricosuria.
• For patients with hypocitraturia or low urine pH, the higher medication costs of adherence may outweigh the savings from averted stone events.
• The cost-effectiveness of PPT is condition-specific, highlighting the importance of tailored treatment strategies.