Clinical and Economic Impact of Implementation of Slow Shockwave Lithotripsy for the Treatment of Urinary Calculi

Abstract

To analyze the impact of slowing the shockwave delivery during extracorporeal shockwave lithotripsy (SWL) on the clinical patient outcome and the cost of delivering this service in a community practice. The data from 1745 consecutive SWL procedures were analyzed at a freestanding surgery center. About 872 treatments were performed at 120 shocks per minute (fast rate [FR]) and 873 were performed at 60 shocks per minute (slow rate [SR]) using a Lithotron machine. Ninety-nine percent of the patients received 3000 shocks. The location and stone size were similar in both groups. Stone-free rate was determined by a plain film of the abdomen at follow-up. The clinical outcome of SR shows a statistically significant improvement in stone-free rate on all stone locations and stone sizes except for those smaller than 25 mm(2). The need for additional secondary treatment decreased from 35.4% to 18.2%. The anesthesia time increased from 26 to 50 minutes per treatment. On the basis of Medicare reimbursement, there was an increase of $28,294 for anesthesia services by going SR. However, the savings realized as a result of decrease in secondary procedures was $264,989, resulting in a total savings of $236,695 during the study period. The cost savings was $271.13 per SWL treatment. The slowing of SWL treatment results in a longer procedure decreasing the time available for treatment; however, the clinical outcome results in improved patient quality of care and decreased cost. Slowing SWL both benefits the patient and decreases the cost of SWL in the community setting.