MP18-11 PEDIATRIC NEPHROLITHIASIS: PRACTICE PATTERNS AND COST OF SURGICAL MANAGEMENT

Abstract

INTRODUCTION AND OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) previously predominated in the surgical management of pediatric nephrolithiasis. More recently, ureteroscopy (URS) has been increasingly utilized as improvements in endoscopic instrumentation have been made. Additionally, studies have demonstrated that URS has better stone-free rates and acceptable complication rates compared to ESWL. This study examines the cost and pattern of surgical management associated with pediatric stones in two private insurer databases. METHODS: Claims from the Humana and Ingenix administrative databases were queried using appropriate current procedural terminology (CPT) and international classification of disease, 9th Revision (ICD-9) codes between 2004 and 2012. Procedural, associated medication, outpatient, and emergency room (ER) utilization and costs were analyzed. RESULTS: 1100 procedures in 618 pediatric patients were identified (368 primary URS, 250 primary ESWL). The average total cost associated with primary URS and ESWL were $2671 95% CI [$2447,2895] and $3,709 95% CI [$3,342,$4076] respectively. ESWL had a higher procedural cost ($2861) compared with primary URS ($1637), p1⁄42.9x10-17. Secondary procedures were more common in the ESWL (19.2%) than the URS (11.4%) cohort, p1⁄40.01. ER and outpatient costs were significantly more in the primary URS group ($891) compared to the ESWL group ($689), p1⁄40.03. Medication cost were similar between the groups, $159 and $143 for ESWL and URS respectively, p1⁄40.14. Primary ESWL declined over the study period from a high of 57.7% cases in 2004 to 25.6% of primary procedures in 2012. CONCLUSIONS: The surgical management of pediatric nephrolithiasis has changed over the 8 year period of study with URS more frequently utilized. Primary ESWL is associated with higher overall cost due to higher procedural cost and increased secondary procedures, while URS is associated with increased outpatient and ER costs but a lower total cost.