Diffusion of new technologies to treat renal stones in Australia

Several new therapies for treating renal stones developed since the 1980s have considerably reduced the use of open surgery and endoscopy for this condition. Extracorporeal shock wave lithotripsy (ESWL) has made the biggest impact. Assessment of ESWL in the early stages of its development assisted in rational introduction of the technology in Australia. However, this effect was short-lived and Australia would now appear to have a significant overcapacity in this technology. Use of ESWL in recent years indicates that distance is a major factor in reducing access to this technology. These observations raise several issues that need addressing, including the limited ability to avoid inappropriate proliferation of a technology, uneven distribution of ESWL units, difficulties of access and the effects of overcapacity upon indications and upon the cost-effectiveness of a technology.