Mp18-10 an efficiency decision-tree for treating urolithiasis up to 3 cm based on a cost-effectiveness analysis

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-10 AN EFFICIENCY DECISION-TREE FOR TREATING UROLITHIASIS UP TO 3 CM BASED ON A COST-EFFECTIVENESS ANALYSIS Adrián Bernal Gómez, Francisco Gómez Palomo, Gema Romeu Magraner, Javier Pérez Ardavín, Pilar Bahílo, Marta Trassierra Villa, Oriol Dagà Martínez, Daniel López Acón, Domingo Guzmán Ordaz Jurado, Oriol Colet, Iván Sáez Moreno, Juan Ortiz, Jaime Bolón, and Alberto Budía Adrián Bernal GómezAdrián Bernal Gómez More articles by this author , Francisco Gómez PalomoFrancisco Gómez Palomo More articles by this author , Gema Romeu MagranerGema Romeu Magraner More articles by this author , Javier Pérez ArdavínJavier Pérez Ardavín More articles by this author , Pilar BahíloPilar Bahílo More articles by this author , Marta Trassierra VillaMarta Trassierra Villa More articles by this author , Oriol Dagà MartínezOriol Dagà Martínez More articles by this author , Daniel López AcónDaniel López Acón More articles by this author , Domingo Guzmán Ordaz JuradoDomingo Guzmán Ordaz Jurado More articles by this author , Oriol ColetOriol Colet More articles by this author , Iván Sáez MorenoIván Sáez Moreno More articles by this author , Juan OrtizJuan Ortiz More articles by this author , Jaime BolónJaime Bolón More articles by this author , and Alberto BudíaAlberto Budía More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our objective is to compare the cost-effectiveness of shock wave lithotripsy (SWL), ureteroscopic lithotripsy (URS), retrograde intrarrenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for treating ureteral and kidney stones up to 3 cm, building a decision tree algorithm based on the efficiency. METHODS: Patients treated for urolithiasis up to 3 cm from 2012 to 2018 were retrospectively reviewed. Treatment modality (SWL, URS, RIRS or PNL) was chosen depending on size, location and radiodensity of the stone. Effectiveness was assessed by the stone-free rate (SFR) at 3 months follow-up. In case of residual stones, retreatment up to four SWL sessions or a second URSL/RIRS/PCNL were included. Average cost per patient were calculated from individual cost of SWL sessions, surgical material and procedures, days of hospitalization, complications and follow-up tests and consultations. A cost-effectiveness analysis was performed and a decision tree algorithm was created. The incremental cost-effectiveness ratio (ICER) was calculated and a Monte Carlo Simulation for a probabilistic sensitivity analysis was carried out. Our study was approved by Ethical Committee. RESULTS: A total of 608 patients were included. In 180 cases of ureteral stones, 95 (52.8%) patients were treated with SWL and 85 (47.2%) patients underwent URS. SWL as first line had a better SFR (99.7%) than URS (97.6%) for ureteral stones regardless of location or size. The overall cost for SWL was 1,445.86 € and for URS group was 2,369.21 €.Among 345 patients with kidney stones <2cm, SWL was used in 201 (58.3%) patients, while 144 (41.7%) patients underwent RIRS. SFR was higher with RIRS (93.8%) than after SWL (80.05%). The average cost of SWL was 1,078.59 €, whereas RIRS expenses were 2,630.86 €. With an estimated ICER of 119 € per extra 1% in SFR, SWL was more efficient in terms of cost-effectiveness than RIRS for kidney stones <2cm. In 83 cases with 2-3 cm renal stones, 62 (74.7 %) patients underwent PCNL and 21 (25.3 %) patients underwent RIRS. SFR for PCNL and RIRS was 95,16% and 95,25 %, respectively. RIRS produced a significantly higher overall cost (6,520.58 €) due to more frequent retreatments than PCNL (3,550.15 €), with an ICER of 16,870.93 €. Sensitivity analysis (Montecarlo simulation) confirmed the results in each comparison. CONCLUSIONS: SWL is the most efficient option in terms of cost-effectiveness for treating ureteral stones and kidney stones <2 cm, while PCNL is more efficient than RIRS for 2-3 cm kidney stones. RIRS may be used to treat stones <2 cm when SWL is not feasible. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e321-e322 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adrián Bernal Gómez More articles by this author Francisco Gómez Palomo More articles by this author Gema Romeu Magraner More articles by this author Javier Pérez Ardavín More articles by this author Pilar Bahílo More articles by this author Marta Trassierra Villa More articles by this author Oriol Dagà Martínez More articles by this author Daniel López Acón More articles by this author Domingo Guzmán Ordaz Jurado More articles by this author Oriol Colet More articles by this author Iván Sáez Moreno More articles by this author Juan Ortiz More articles by this author Jaime Bolón More articles by this author Alberto Budía More articles by this author Expand All Advertisement Loading ...