134 COST-EFFECTIVENESS OF SHOCK WAVE FREQUENCIES OF 60 VERSUS 120 SHOCKS PER MINUTE FOR TREATMENT OF UPPER URETERAL STONES: ECONOMIC ANALYSIS OF A RANDOMIZED, DOUBLE-BLIND TRIAL

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2012134 COST-EFFECTIVENESS OF SHOCK WAVE FREQUENCIES OF 60 VERSUS 120 SHOCKS PER MINUTE FOR TREATMENT OF UPPER URETERAL STONES: ECONOMIC ANALYSIS OF A RANDOMIZED, DOUBLE-BLIND TRIAL Zachary Klinghoffer, Vincent Tu, and Kenneth Pace Zachary KlinghofferZachary Klinghoffer Hamilton, Canada More articles by this author , Vincent TuVincent Tu Hamilton, Canada More articles by this author , and Kenneth PaceKenneth Pace Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.183AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Increasing evidence suggests that lower shockwave frequencies may improve stone fragmentation rates at the expense of longer operative times. The purpose of our study was to compare the cost-effectiveness of shockwave frequencies of 60 and 120 shocks per minute for primary treatment of upper ureteral stones. METHODS A decision analysis model was developed to estimate the costs and stone-free rates associated with treatment at shockwave frequencies of 60 and 120 shocks per minute. Stone-free rates and probabilities of requiring ancillary procedures, including shockwave lithotripsy re-treatment, ureteroscopy with laser lithotripsy and percutaneous nephrolithotomy, following primary treatment were derived from our previously published randomized, double-blind trial. Costs of shockwave lithotripsy at 60 and 120 shocks per minute were obtained from our institutional data. Costs of ancillary procedures were obtained from the Ontario Case Costing Initiative. Univariate and probabilistic sensitivity analyses were performed to determine which parameters affected the outcome of our model. RESULTS Primary treatment of upper ureteral stones with shockwave lithotripsy at 60 shocks per minute was the more cost-effective treatment strategy, rendering one patient stone-free for $1,925 Canadian dollars (CAD). Shockwave lithotripsy at 120 shocks per minute rendered one patient stone-free for $2,178 CAD. Univariate sensitivity analysis demonstrated our model to be robust to changes to key parameters. Probabilistic sensitivity analysis reinforced shockwave lithotripsy at 60 shocks per minute as the more cost-effective treatment strategy compared to 120 shocks per minute across all willingness-to-pay thresholds. CONCLUSIONS Primary treatment of upper ureteral stones with shockwave lithotripsy at 60 shocks per minute is more cost-effective than treatment at 120 shocks per minute. Our study demonstrates that although the cost of initial treatment at 60 shocks per minute exceeds that of treatment at 120 shocks per minute due to increased operative times, treatment at 60 shocks per minute is more cost-effective due to the decreased need for ancillary treatments. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e55 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Klinghoffer Hamilton, Canada More articles by this author Vincent Tu Hamilton, Canada More articles by this author Kenneth Pace Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...