Ar. Levy et M. Mcgregor, HOW HAS EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY CHANGED THE TREATMENT OF URINARY STONES IN QUEBEC, CMAJ. Canadian Medical Association journal, 153(12), 1995, pp. 1729-1736
Objectives: To determine the number of people who underwent treatment
of urinary stones in Quebec before and after the introduction of extra
corporeal shock-wave lithotripsy (ESWL) and to determine how the intro
duction of ESWL influenced resource utilization. Design: Before-after
study; data were obtained from administrative databases and hospital-b
ased cost estimates. Setting: The 68 acute care hospitals in Quebec in
which treatment of urinary stones is undertaken. Patients: Quebec res
idents admitted to hospital for treatment of urinary stones between th
e fiscal years 1984 and 1992. Outcome measures: Number of people treat
ed for urinary stones per year, total number of procedures per year (i
ncluding open surgery, percutaneous procedures, retrograde procedures
and ESWL), and annual resources (including number of hospital bed-days
and direct costs) for treatment of urinary stones used overall and in
hospitals with and without ESWL services. Results: Over the study per
iod the number of people treated for urinary stones increased by 59%.
As well, the combined frequency of ESWL and surgery (the two main trea
tment methods) increased by 107%. These increases were largely due to
rates of treatment that grew by 52% among women and by 34% among men.
The total number of hospital bed-days decreased by 28%, which reflecte
d shorter hospital stays for ESWL. However, despite this decrease, the
total direct annual costs were 7% higher in 1992 than in 1984 because
of the increased numbers of people treated and procedures performed.
In the three hospitals that offered ESWL the number of hospital bed-da
ys and the direct costs of treating urinary stones increased by 49% an
d $2.5 million respectively. In the 65 other hospitals these figures d
ecreased by 41% and about $2.9 million respectively. Conclusions: Beca
use of increased intervention rates the total cost of treating urinary
stones has risen since the introduction of ESWL. The introduction of
ESWL has also been associated with a shift in the use of resources for
treating urinary stones to hospitals with a lithotriptor. The reasons
for the increased intervention rates are unknown. However, given the
possibility of negative health effects and the increased costs, studie
s to determine whether the increased rates improve health outcomes are
warranted.