Stephan Seklehner1,2, Karl-Dietrich Sievert3, Richard Lee4, Paul F Engelhardt5,3, Claus Riedl5, Thomas Kunit3. 1. Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria. st.seklehner@gmx.net. 2. Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria. st.seklehner@gmx.net. 3. Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria. 4. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA. 5. Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria.
Abstract
OBJECTIVE: To evaluate the outcome and the costs of stenting in uncomplicated semirigid ureteroscopic stone removal. MATERIALS AND METHODS: A decision tree model was created to evaluate the economic impact of routine stenting versus non-stenting strategies in uncomplicated ureteroscopy (URS). Probabilities of complications were extracted from twelve randomized controlled trials. Stone removal costs, costs for complication management, and total costs were calculated using Treeage Pro (TreeAge Pro Healthcare version 2015, Software, Inc, Williamstown Massachusetts, USA). RESULTS: Stone removal costs were higher in stented URS (€1512.25 vs. €1681.21, respectively). Complication management costs were higher in non-stented procedures. Both for complications treated conservatively (€189.43 vs. €109.67) and surgically (€49.26 vs. €24.83). When stone removal costs, costs for stent removal, and costs for complication management were considered, uncomplicated URS with stent placement yielded an overall cost per patient of €1889.15 compared to €1750.94 without stent placement. The incremental costs of stented URS were €138.25 per procedure. CONCLUSION: Semirigid URS with stent placement leads to higher direct procedural costs. Costs for managing URS-related complications are higher in non-stented procedures. Overall, a standard strategy of deferring routine stenting uncomplicated ureteroscopic stone removal is more cost efficient.
OBJECTIVE: To evaluate the outcome and the costs of stenting in uncomplicated semirigid ureteroscopic stone removal. MATERIALS AND METHODS: A decision tree model was created to evaluate the economic impact of routine stenting versus non-stenting strategies in uncomplicated ureteroscopy (URS). Probabilities of complications were extracted from twelve randomized controlled trials. Stone removal costs, costs for complication management, and total costs were calculated using Treeage Pro (TreeAge Pro Healthcare version 2015, Software, Inc, Williamstown Massachusetts, USA). RESULTS: Stone removal costs were higher in stented URS (€1512.25 vs. €1681.21, respectively). Complication management costs were higher in non-stented procedures. Both for complications treated conservatively (€189.43 vs. €109.67) and surgically (€49.26 vs. €24.83). When stone removal costs, costs for stent removal, and costs for complication management were considered, uncomplicated URS with stent placement yielded an overall cost per patient of €1889.15 compared to €1750.94 without stent placement. The incremental costs of stented URS were €138.25 per procedure. CONCLUSION: Semirigid URS with stent placement leads to higher direct procedural costs. Costs for managing URS-related complications are higher in non-stented procedures. Overall, a standard strategy of deferring routine stenting uncomplicated ureteroscopic stone removal is more cost efficient.
Authors: Enrique Perez Castro; Palle J S Osther; Viorel Jinga; Hassan Razvi; Konstantinos G Stravodimos; Kandarp Parikh; Ali R Kural; Jean J de la Rosette Journal: Eur Urol Date: 2014-01-23 Impact factor: 20.096