MP27-05 COMPARATIVE COST-EFFECTIVENESS OF PERCUTANEOUS NEPHROLITHOTOMY, URETEROSCOPY, AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR THE MANAGEMENT OF 1-2CM RENAL STONES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures (MP27)1 Apr 2020MP27-05 COMPARATIVE COST-EFFECTIVENESS OF PERCUTANEOUS NEPHROLITHOTOMY, URETEROSCOPY, AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR THE MANAGEMENT OF 1-2CM RENAL STONES Kevin Wymer*, Tristan Juvet, Vidit Sharma, Aaron Potretzke, Deepak Agarwal, Marcelino Rivera, and Matthew Gettman Kevin Wymer*Kevin Wymer* More articles by this author , Tristan JuvetTristan Juvet More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Deepak AgarwalDeepak Agarwal More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and Matthew GettmanMatthew Gettman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000866.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guidelines for the treatment of renal stones 1-2cm in size include ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL). A recent meta-analysis comparing these treatments found the highest stone-free rate with PCNL, followed by URS and ESWL; however, complication rates were highest for PCNL. A cost-effectiveness evaluation comparing these three modalities has not yet been performed. METHODS: A Markov decision analytic model was created to compare cost-effectiveness of PCNL, URS, and ESWL for 1-2cm renal stones based on stone free and complication rates from a meta-analysis. Costs were based on 2018 Medicare rates. Quality adjusted life years (QALYs) were assigned from the literature. The incremental cost-effectiveness ratio (ICER) between strategies was compared, using a willingness-to-pay (WTP) threshold of $100,000/QALY. Univariate and multivariable Monte Carlo sensitivity analyses were performed. A subset analysis was performed for 1-2cm lower pole stones. RESULTS: At 3 years follow up, mean costs per patient were $10,079 (PCNL), $5,779 (URS), and $4,804 (ESWL). PCNL resulted in the highest QALYs at 2.97 compared to 2.96 and 2.95 for URS and ESWL, respectively. On aggregate, PCNL was not cost-effective relative to ESWL ($302,751/QALY) or URS ($1,466,110/QALY), whereas URS was more cost-effective than ESWL (ICER=$67,257/QALY). The model was sensitive to the stone free rate of ESWL and URS as well as the cost of PCNL, URS, and ESWL. ESWL became most cost-effective with a stone free rate ≥69% or URS stone free rate ≤82%. PCNL became most cost-effective when cost ≤$5,205. On multivariable sensitivity analysis, the most cost-effective strategy was URS in 67%, ESWL in 32.5%, and PCNL in 0.5% of simulations. When evaluating lower pole stones alone, the most cost-effective strategy was URS in 84%, ESWL in 8%, and PCNL in 8% of microsimulations (Figure). CONCLUSIONS: For 1-2 cm stones, URS is most likely to be cost-effective on a population level based on data from meta-analyses. However, for lower pole stones, particularly with a higher willingness to pay threshold, PCNL becomes increasingly favorable. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e411-e411 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Wymer* More articles by this author Tristan Juvet More articles by this author Vidit Sharma More articles by this author Aaron Potretzke More articles by this author Deepak Agarwal More articles by this author Marcelino Rivera More articles by this author Matthew Gettman More articles by this author Expand All Advertisement PDF downloadLoading ...