EFFICACY AND COST-EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR SOLITARY LOWER POLE RENAL CALCULI
- 1 January 1998
- journal article
- research article
- Published by Wolters Kluwer Health in Journal of Urology
- Vol. 159 (1), 24-27
- https://doi.org/10.1016/s0022-5347(01)63999-5
Abstract
We determined the efficacy of extracorporeal shock wave lithotripsy monotherapy and compared its cost-effectiveness with percutaneous nephrolithotomy for the management of lower pole renal calculi. The efficacy (stone-free rates at 3-months posttreatment) of shock wave lithotripsy with the modified Dornier HM3* machine was determined retrospectively in 114 patients with solitary lower pole renal calculi. Using cost data available from patient billing charges and efficacy data from the literature, the cost-effectiveness for percutaneous nephrolithotomy and shock wave lithotripsy as primary therapy was evaluated. To make this cost-effectiveness comparison, we developed a decision analysis model in which a patient in whom primary therapy failed was rendered stone-free with a secondary percutaneous nephrolithotomy procedure. The stone-free rates of solitary lower pole stones with a size range of less than 10, 11 to 20 and greater than 20 mm. were 76, 74 and 33%, respectively, with a single shock wave lithotripsy treatment. Based on average treatment costs for shock wave lithotripsy and percutaneous nephrolithotomy, the model results show that for stone sizes less than 2 cm. primary lithotripsy therapy followed by nephrolithotomy for failed cases is the least costly approach. For stone sizes greater than 2 cm. primary percutaneous nephrolithotomy may be more cost-effective. Whereas shock wave lithotripsy with the Dornier HM3 should be considered the initial treatment choice for most lower pole stones less than 2 cm., primary percutaneous nephrolithotomy should be considered for stones larger than 2 cm.Keywords
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