Contemporary Assessment of the Economic Burden of Upper Urinary Tract Stone Disease in the United States: Analysis of 1-year Healthcare Costs, 2011-2018 - Beyond the Abstract

In the setting of our ever-evolving healthcare system, analyzing modern spending patterns is a colossal task with important implications including how we participate in the present and plan for future healthcare delivery.

In our study, we illustrate the rising prevalence of upper urinary tract stone disease (USD) amid robust healthcare shifts with implementation of the Affordable Care Act; yet data surrounding economic contributions of these patterns were lacking. In order to assess true 1-year healthcare costs, we utilized the PearlDiver-Mariner database. PearlDiver-Mariner is an all-payer (Commercial, Medicare, Medicaid, Government, and Cash) database that houses data from over 122 million distinct patients in the United States from 2010 – 2019 and provides cost of care data in the form of actual insurance reimbursements.1

The utility of national databases in healthcare research have gained unanimous popularity, especially in the setting of the Patient Protection Affordable Care Act.2 From cost analysis to risk stratification development to outcome measures, large-volume databases have provided unique insights contributing to our understanding of healthcare evaluation and delivery. In surgical subspecialties specifically, large-volume databases have allowed for study of rare disease, uncommon complications, utilization trends, and drivers of procedural variation and cost. While these databases present novel information and opportunities, the multiple national databases currently available are highly variable.2,3 For example, another well-designed study evaluated cost variation in stone disease in the United States as well using Vizient, another national database, but with the limitation of access to only inpatient procedure data.4 An important distinction among national databases is their categorization as administration versus clinical. Administrative databases, like National Inpatient Sample (NIS), Center for Medicare and Medicaid Services Medicare Database (CMS), PearlDiver, MarketScan, and Premier, are the products of billing data gathered from insurance requests and claims. On the contrary, clinical databases, like National Surgical Quality Improvement Program (NSQIP) and National Trauma Data Bank Research Dataset (NTDBRDS) are an amalgamation of specific patient information for tracking information. PearlDiver is unique in its ability to synthesize data from all-payers in both private and government sectors, allowing us to answer our clinical question and provide a holistic analysis of the economic burden of stone disease. Each database has their respective abilities and limitations; understanding these differences in capability and utility is essential to fuel these studies.

In the realm of stone disease, increasing prevalence, technological advances, and novel surgical approaches have shifted management strategies and spending patterns. Outside the operating room, our healthcare system is rapidly evolving warranting a simultaneous drive to study the economic impacts, which we believe can be well-executed and supplemented by national database studies like ours.

Written by: Adan Zapien Becerra, Johnathan Alexander Khusid, Morgan R Sturgis, Lauren Fink, Mantu Gupta, Badrinath Konety, Ephrem Olweny

Rush University Medical Center, 2468, Surgery, 1735 W. Harrison St., Chicago, Chicago, Illinois, United States, 60612-3833, Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave Levy Pl., New York, New York, United States, 10029-6574, Rush University Medical Center, 2468, Chicago, Illinois, United States., Brooklyn, United States, Mount Sinai Health System, 5944, Urology, 425 W. 59th Street, New York, New York, United States, 10019, Chicago, United States, Chicago, United States


  1. PearlDiver Healthcare Research. 
  2. Alluri RK, Leland H, Heckmann N. Surgical research using national databases. Ann Transl Med. 2016;4(20):393. doi:10.21037/atm.2016.10.49 
  3. Karhade AV, Larsen AMG, Cote DJ, Dubois HM, Smith TR. National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations. Neurosurgery. 2018 Sep 1;83(3):333-344. doi: 10.1093/neuros/nyx408. PMID: 28950367.
  4. Abello A, Goland-Van Ryn M, Kenney PA, Singh D, Motamedinia P. Analysis of Cost Variation in Endourological Procedures throughout the United States Using a National Database. 2020; 7(3): 174-181.

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