To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies.
A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS.
Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays' practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.
Current opinion in urology. 2024 Aug 20 [Epub ahead of print]
Carlotta Nedbal, Pietro Tramanzoli, Daniele Castellani, Vineet Gauhar, Andrea Gregori, Bhaskar Somani
Urology Unit, ASST Fatebenefratelli Sacco, Milano., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Le Marche, Ancona, Italy., Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK.