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• W2077417480 abstract "No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Apr 2002Management Of Ureteral Calculi: A Cost Comparison And Decision Making Analysis Yair Lotan, Matthew T. Gettman, Claus G. Roehrborn, Jeffrey A. Cadeddu, and Margaret S. Pearle Yair LotanYair Lotan More articles by this author , Matthew T. GettmanMatthew T. Gettman More articles by this author , Claus G. RoehrbornClaus G. Roehrborn More articles by this author , Jeffrey A. CadedduJeffrey A. Cadeddu More articles by this author , and Margaret S. PearleMargaret S. Pearle More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65166-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared the cost of treatment strategies for ureteral calculi using a decision tree model. Materials and Methods: A comprehensive literature review was performed to determine the average success rate of each of 3 treatment modalities, namely observation, ureteroscopy and shock wave lithotripsy. Using these success rates decision analysis models were constructed using Data 3.5 software (TreeAge Software, Inc., Williamstown, Massachusetts) to estimate the cost of treatment and followup for each of the 3 treatments. One-way sensitivity analysis was performed to evaluate the effect of varying individual probabilities of success and costs, and 2-way sensitivity analysis was done to evaluate the model for a wide range of potential costs and success rates of ureteroscopy and shock wave lithotripsy. In addition, a table was constructed to enable individual surgeons and institutions to determine the cost impact of ureteroscopy and shock wave lithotripsy in their unique clinical scenarios. Results: Observation was the least costly pathway if no financial cost, such as emergency room visits, was incurred by failed observation. Ureteroscopy was less costly than shock wave lithotripsy for stones at all ureteral locations. A cost difference between the 2 modalities of approximately $1,440, $1,670 and $1,750 was noted for proximal, mid and distal ureteral calculi, respectively. One-way sensitivity analysis showed that the cost of ureteroscopy would have to increase by more than $1,400, $1,700 and $1,850, and the success rate would have to decrease by 28%, 36% and 39% for proximal, mid and distal stones, respectively, before reaching cost equivalence with shock wave lithotripsy. Likewise, the cost of shock wave lithotripsy would have to decrease by more than $1,489 to achieve cost equivalence with ureteroscopy. Overall ureteroscopy was more cost-effective at all stone sites regardless of the success rate of shock wave lithotripsy. Conclusions: Ureteroscopy is the most cost-effective treatment strategy for ureteral stones at all locations after observation fails. The high cost of purchasing and maintaining a lithotriptor is responsible for the high treatment cost associated with shock wave lithotripsy. However, cost is only one of a number of important factors that are considered when determining an appropriate treatment strategy. References 1 : Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. American Urological Association. J Urol1997; 158: 1915. Link, Google Scholar 2 : Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol1993; 24: 172. Google Scholar 3 : Ureteroscopy: current practice and long-term complications. J Urol1997; 157: 28. Link, Google Scholar 4 : Nonstent or noncatheter extracorporeal shock-wave lithotripsy for ureteral stones. Urology1994; 43: 178. 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Google Scholar From the Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byPatel P, Koehne E, Chen V, Nelson M, Baker M, Gupta G and Baldea K (2020) Initial Extracorporeal Shockwave Lithotripsy versus Ureteroscopy: A Re-treatment and Cost Analysis Using a Longitudinal, Population-Based DatabaseUrology Practice, VOL. 8, NO. 2, (203-208), Online publication date: 1-Mar-2021.Pollard M, Laviana A, Kaplan A, Pagan C and Saigal C (2017) Time-Driven Activity-Based Costing Analysis of Urological Stone DiseaseUrology Practice, VOL. 5, NO. 5, (327-333), Online publication date: 1-Sep-2018.Loftus C, Nyame Y, Hinck B, Greene D, Chaparala H, Alazem K and Monga M (2015) Medical Expulsive Therapy is Underused for the Management of Renal Colic in the Emergency SettingJournal of Urology, VOL. 195, NO. 4 Part 1, (987-991), Online publication date: 1-Apr-2016.Wang H, Wiener J, Lipkin M, Scales C, Ross S and Routh J (2014) Estimating the Nationwide, Hospital Based Economic Impact of Pediatric UrolithiasisJournal of Urology, VOL. 193, NO. 5S, (1855-1859), Online publication date: 1-May-2015.Özcan C, Aydoğdu O, Senocak C, Damar E, Eraslan A, Oztuna D and Bozkurt O (2015) Predictive Factors for Spontaneous Stone Passage and the Potential Role of Serum C-Reactive Protein in Patients with 4 to 10 mm Distal Ureteral Stones: A Prospective Clinical StudyJournal of Urology, VOL. 194, NO. 4, (1009-1013), Online publication date: 1-Oct-2015.Matlaga B, Jansen J, Meckley L, Byrne T and Lingeman J (2012) Economic Outcomes of Treatment for Ureteral and Renal Stones: A Systematic Literature ReviewJournal of Urology, VOL. 188, NO. 2, (449-454), Online publication date: 1-Aug-2012.Scales C, Krupski T, Curtis L, Matlaga B, Lotan Y, Pearle M, Saigal C and Preminger G (2011) Practice Variation in the Surgical Management of Urinary LithiasisJournal of Urology, VOL. 186, NO. 1, (146-150), Online publication date: 1-Jul-2011.Kijvikai K, Haleblian G, Preminger G and de la Rosette J (2007) Shock Wave Lithotripsy or Ureteroscopy for the Management of Proximal Ureteral Calculi: An Old Discussion RevisitedJournal of Urology, VOL. 178, NO. 4, (1157-1163), Online publication date: 1-Oct-2007.DELLABELLA M, MILANESE G and MUZZONIGRO G (2018) RANDOMIZED TRIAL OF THE EFFICACY OF TAMSULOSIN, NIFEDIPINE AND PHLOROGLUCINOL IN MEDICAL EXPULSIVE THERAPY FOR DISTAL URETERAL CALCULIJournal of Urology, VOL. 174, NO. 1, (167-172), Online publication date: 1-Jul-2005.PORPIGLIA F, GHIGNONE G, FIORI C, FONTANA D and SCARPA R (2018) NIFEDIPINE VERSUS TAMSULOSIN FOR THE MANAGEMENT OF LOWER URETERAL STONESJournal of Urology, VOL. 172, NO. 2, (568-571), Online publication date: 1-Aug-2004.DELLABELLA M, MILANESE G and MUZZONIGRO G (2018) Efficacy of Tamsulosin in the Medical Management of Juxtavesical Ureteral StonesJournal of Urology, VOL. 170, NO. 6, (2202-2205), Online publication date: 1-Dec-2003. Volume 167Issue 4April 2002Page: 1621-1629 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsureteral calculiureteroscopylithotripsyuretercost-benefit analysisMetricsAuthor Information Yair Lotan More articles by this author Matthew T. Gettman More articles by this author Claus G. Roehrborn More articles by this author Jeffrey A. Cadeddu More articles by this author Margaret S. Pearle More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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