1816 EXPULSIVE THERAPY VERSUS EARLY ENDOSCOPIC STONE REMOVAL IN ACUTE RENAL COLIC: A COMPARISON OF INDIRECT COSTS

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (III)1 Apr 20131816 EXPULSIVE THERAPY VERSUS EARLY ENDOSCOPIC STONE REMOVAL IN ACUTE RENAL COLIC: A COMPARISON OF INDIRECT COSTS Casey A. Dauw, Gary J. Faerber, Brent K. Hollenbeck, Samuel R. Kaufman, William W. Roberts, J. Stuart Wolf, and John M. Hollingsworth Casey A. DauwCasey A. Dauw Ann Arbor, MI More articles by this author , Gary J. FaerberGary J. Faerber Ann Arbor, MI More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck Ann Arbor, MI More articles by this author , Samuel R. KaufmanSamuel R. Kaufman Ann Arbor, MI More articles by this author , William W. RobertsWilliam W. Roberts Ann Arbor, MI More articles by this author , J. Stuart WolfJ. Stuart Wolf Ann Arbor, MI More articles by this author , and John M. HollingsworthJohn M. Hollingsworth Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2179AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES When compared with early endoscopic stone removal, an initial trial of medical expulsive therapy (MET) is associated with lower total expenditures around episodes of acute renal colic. However, the effects of MET on indirect costs (e.g., lost productivity) have not been examined. Since these costs are arguably more important to the patient, we compared differences in filings for short-term disability between patients prescribed MET and those treated with stone surgery. METHODS Using a previously validated claims-based algorithm, we identified a cohort of patients with acute renal colic. After determining their upfront treatment type (i.e., an initial course of MET versus early endoscopic stone removal), we then compared differences in their rates of short-term disability filing. To help adjust for possible selection bias, we used propensity score matching to construct MET and surgery groups that had similar distributions on many covariates. RESULTS In total, 257 (36.8%) and 461 (64.2%) patients with acute renal colic underwent MET or endoscopic stone removal, respectively. Baseline differences existed between the two groups with respect to their employee classification (P=.007) and urban rural status (P=.001). These differences disappeared with propensity score matching (Table). In the matched cohort, patients treated with MET were 66% less likely to file a short-term disability claim when compared to those undergoing endoscopic stone removal (OR, 0.34, 95% CI, 0.19 to 0.61). Among patients who filed short-term disability claims, those prescribed MET had, on average, 1.5 fewer days of disability than those treated surgically (1.4 versus 2.9 day, P=0.003). CONCLUSIONS An initial trial of MET is associated with significantly lower indirect costs to the patient when compared to early endoscopic stone removal. These findings have implications for providers when counseling patients with acute renal colic. Patient Characteristic Endoscopic Stone Removal Medical Expulsive Therapy P-Value Patient Age, mean 46.2 46.2 0.837 % Female 7.7 12.9 0.067 % Benefit Plan Type 0.590 Comprehensive 17.3 21.1 Preferred Provider Organization 0.0 0.4 Point of Service 18.2 18.0 Other, Non-Capitated 64.6 60.6 % Salaried 56.4 59.0 0.564 % Full-Time Employment 93.2 89.8 0.196 % Urban 90.0 89.1 0.739 Region of Residence,% 0.994 Northeast 12.3 12.5 Midwest 48.2 49.2 South 33.6 32.4 West 5.9 5.9 Charlson Score,% 0.870 0 91.8 89.5 1 5.9 7.8 2 1.4 1.6 ≥3 0.9 1.2 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e747 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Casey A. Dauw Ann Arbor, MI More articles by this author Gary J. Faerber Ann Arbor, MI More articles by this author Brent K. Hollenbeck Ann Arbor, MI More articles by this author Samuel R. Kaufman Ann Arbor, MI More articles by this author William W. Roberts Ann Arbor, MI More articles by this author J. Stuart Wolf Ann Arbor, MI More articles by this author John M. Hollingsworth Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...