Cost and effectiveness of different treatment alternatives in urinary stone practice

The cost and effectiveness of seventy-six consecutive percutaneous nephrolithotomy (PNL) procedures performed during the years 1990-1992, a sample of 425 ESWL patients with 675 treatments from 1991-1992, and 45 successive open pyelolithotomies (PL) performed before the advent of the new stone treatment techniques during the years 1981-1985, were studied for each of the treatment modalities. The costs were counted per patient and based on the cumulative charge of the procedures, cost for in-patient care, and treatment of additional procedures and operatively treated complications. The results showed that the great majority of ESWL patients were treated at a low cost and with few additional procedures and complications compared to PNL, particularly, when stones smaller than 20 mm were treated. Considering all the patients, the cumulative mean hospital cost per patient without the cost for the follow-up was as follows, FIM (pound): PL 33860(4200), PNL 63360(7860), and ESWL 17430(2160). The remarkable number of additional and auxiliary measures (including the pre- and post-operative ESWL procedures) resulted in considerable extra costs for the PNL patients until they were rendered stone-free. Another series comprising 42 successive patients with 48 stone basket procedures (SB) from the years 1981-1985 was retrospectively compared to 42 patients with 50 ureteroscopic stone extractions (URS) between January 1985 and April 1988 before the beginning of the ESWL practice in Finland as well as to 54 patients with 79 ESWL treatments for a lower ureteric stone during the years 1991-1992. The stone-free status after the three procedures until one month was 71, 66, and 60%, with no statistically significant difference. In the group of lower ureteric stones the cumulative mean hospital cost per patient was as follows, FIM (pound): SB 19520(2420), URS 17750(2200), and ESWL 17810(2210). Also in the treatment of lower ureteric stones, ESWL is an equally cost-effective method representing an alternative worth consideration, particularly for patients preferring a minimally invasive urinary stone treatment.