COMPARATIVE COSTS OF THE VARIOUS STRATEGIES OF URINARY STONE DISEASE MANAGEMENT

New technology is a major determinant of total healthcare costs. The a ssessment of alternative technologies from a cost-effectiveness perspe ctive is important, although other considerations may finally determin e which technology is used. The alternatives of extracorporeal shock w ave lithotripsy (ESWL) and percutaneous nephrostolithotomy (PCNL) for the treatment of renal stone disease were compared by studying 1000 ca ses of ESWL and 133 cases of PCNL using a noncontemporaneous cohort st udy with PCNL representing the earlier cohort. The effectiveness, defi ned by success and stone-free rates, was higher with PCNL than with ES WL (96% success vs. 70%); PCNL was also accompanied by a lower burden of additional therapy, whereas ESWL had a higher retreatment rate. Fro m the perspective of a third-party payer, total costs per case of ESWL ($2,746) were lower than those of PCNL ($4,087), but the figure varie s with the annual volume. These represent the costs for complete treat ment of a patient, including the costs of alternative technology such as PCNL or ureteroscopy that may ultimately be necessary in a patient initially managed by ESWL. The cost for a single ESWL treatment was $2 ,226 (at a volume of 1000 cases per year), but this increased to $2,74 6 when costs of retreatment and alternative treatment were prorated to each patient treated. The relative contribution of capital costs to t he total cost of ESWL was always less than total professional fees and was only 12% at a volume of 2000 cases/year. Therefore ESWL is less e xpensive but it is also less effective in rendering patients stone-fre e.