MP39-10 SIMULTANEOUS BILATERAL PCNL: IS IT COST-EFFECTIVE?

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP39-10 SIMULTANEOUS BILATERAL PCNL: IS IT COST-EFFECTIVE? Kevin Wymer, Ben Johnson, Austen Slade, Daniel Heidenberg, Mitchell Humphreys, Karen Stern, and Marcelino Rivera Kevin WymerKevin Wymer More articles by this author , Ben JohnsonBen Johnson More articles by this author , Austen SladeAusten Slade More articles by this author , Daniel HeidenbergDaniel Heidenberg More articles by this author , Mitchell HumphreysMitchell Humphreys More articles by this author , Karen SternKaren Stern More articles by this author , and Marcelino RiveraMarcelino Rivera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Large, bilateral stone burden can present a unique challenge for both the urologist and patient. When bilateral PCNL is warranted, surgical timing can lead to differences in stone free rate (SFR), complications, and costs. This study compares the cost-effectiveness of simultaneous versus staged PCNL. METHODS: A decision-analytic Markov model was used to assess the cost-effectiveness of simultaneous (bilateral PCNL during a single operative episode for the index procedure) and staged (unilateral PCNL for the index procedure followed by a separate procedure for a contralateral PCNL) PCNL for the management of large, bilateral stone burden. Model probabilities and outcomes for index procedures, including SFR, complications, operative time, and hospital length of stay (LOS), were drawn from a large-volume, single-center cohort. Outcomes for secondary procedures and utility values were obtained from the literature. Primary outcomes included costs from a Medicare standpoint with the addition of operative time and LOS costs, effectiveness (quality adjusted life years, QALYs), and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to evaluate the robustness of the model. RESULTS: At 1 year following the index procedure, costs (inclusive of index procedure, secondary procedures, and complications) per patient were $52,585 and $61,687 for simultaneous and staged PCNL, respectively. In addition to being less costly, simultaneous PCNL also resulted in slightly higher QALYs (.982) compared to staged PCNL (.977). On one-way sensitivity analyses (Figure), staged PCNL became cost-effective if the SFR increased from 56% to 88% (40% greater per renal unit relative to simultaneous PCNL) or the cost of unilateral PCNL decreased approximately 50% to $4,699 ($16,266 less than simultaneous PCNL). CONCLUSIONS: Even when assuming a modest reduction in SFR (62% vs. 44% per renal unit), longer index procedure OR time (177 vs. 116 minutes) and LOS (3.2 vs. 2.3 days) and slightly higher major (6.2% vs. 5.5%) and minor (27.2% vs. 21.3%) complication rates at index procedure, simultaneous bilateral PCNL was both less costly and more effective at 1 year follow up relative to staged bilateral PCNL. This offers further support of simultaneous bilateral PCNL in the proper clinical setting. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e538 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Wymer More articles by this author Ben Johnson More articles by this author Austen Slade More articles by this author Daniel Heidenberg More articles by this author Mitchell Humphreys More articles by this author Karen Stern More articles by this author Marcelino Rivera More articles by this author Expand All Advertisement PDF downloadLoading ...