SWL is more cost-effective than ureteroscopy and Holmium:YAG laser lithotripsy for ureteric stones: A comparative analysis for a tertiary referral centre

Abstract 

Background

To identify the most cost-effective treatment for ureteric stones ≤15mm in our department, by using an economic model to compare the total cost of shockwave lithotripsy (SWL) versus ureteroscopy with Holmium:YAG laser lithotripsy (URSL).

Patients and methods

Data for patients treated with the same lithotriptor were retrospectively analyzed. The financial department provided data about the cost of procedures. This model accepted a 100% stone-free rate for URSL in outpatients, and a 50% rate of insertion of a ureteric stent. The cost for each procedure to render a patient stone-free was estimated by the following equations:

a.

b.

Results

Records of 228 patients with previously untreated solitary radiopaque ureteric stones ≤15mm were reviewed. The total cost for SWL (cSWL) was £1491/patient, while the total cost for URSL (cURSL) was £2195/patient. The difference was highest in the upper ureter (over £1000), and lowest in the distal part (URSL about 40% more expensive). For lower ureteric stones >10mm, SWL was over £500 more expensive than URSL.

Conclusion

Using data from the department to calculate cost-effectiveness for ureteric stones ≤15mm a difference in favour of SWL versus URSL was found. Uniform guidelines incorporating cost are impossible considering differences between countries; each centre should probably assess their data individually.

Abbreviations: SWL, shockwave lithotripsy, URSL, ureteroscopy with Holmium:YAG laser lithotripsy, MET, medical expulsive treatment, AUA, American Urological Association, EAU, European Association of Urology, SLC, The Scottish Lithotriptor Centre, SFR, stone-free rate, RCTs, randomized controlled trials, EBM, evidence-based medicine

Keywords: Cost-effective, Evidence-based medicine, Outcome, Shockwave lithotripsy, Ureteric stones, Ureteroscopy