Economics and cost of care of stone disease.

Nephrolithiasis is associated with a high cost to society because of the high prevalence of disease and high recurrence rates. The total annual medical expenditures for urolithiasis in the United States were estimated at $2.1 billion in 2000. The cost of stone disease reflects the cost of health care services required to manage stone disease and the rate of utilization. Although the care of individuals with urolithiasis has shifted from the inpatient to the outpatient setting and the hospital length of stay has decreased, costs continue to rise because of increases in the prevalence of kidney stones. There are 2 potential areas that would allow for a decrease in stone disease-related costs, lower health care-related costs, and decreased prevalence of stone disease. Reducing treatment-related costs are unlikely to provide a solution to the high cost of caring for stone disease because physician-fee reductions did not result in a significant reduction in costs. Furthermore, there are no significant advancements in surgical technique or technologies in the horizon. One area of cost savings could be to develop better guidelines for acute management, optimizing timing for surgery in acute settings and increasing the practice of medical expulsive therapy. Another area with potential to reduce costs is the reduction of overall stone burden through the prevention of new stones or recurrences. Strategies for primary prevention in high-risk populations have not been studied and represent an area for future research. More efforts should be made to improve medical management of stone formers. These efforts include improving dietary recommendations, identifying barriers to evaluations and treatment of recurrent stone formers, improving patient compliance with recommendations, and development of new medications.