MP54-06 IS AN INCREASE OF FOCAL SHOCK WAVE ENERGY THROUGH AN EXPANDED NUMBER OF SHOCKWAVES PER SESIÓN EFFICIENT AND SAFE IN EXTRACORPOREAL LITHOTRIPSY? A COST-EFFECTIVENESS ANALYSIS.

Abstract

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2016MP54-06 IS AN INCREASE OF FOCAL SHOCK WAVE ENERGY THROUGH AN EXPANDED NUMBER OF SHOCKWAVES PER SESIÓN EFFICIENT AND SAFE IN EXTRACORPOREAL LITHOTRIPSY? A COST-EFFECTIVENESS ANALYSIS. Alberto Budía, Vicent Caballer, José Daniel López-Acón, David Vivas-Consuelo, Pilar Bahílo, Marta Trassierra, and Francisco Boronat Alberto BudíaAlberto Budía More articles by this author , Vicent CaballerVicent Caballer More articles by this author , José Daniel López-AcónJosé Daniel López-Acón More articles by this author , David Vivas-ConsueloDavid Vivas-Consuelo More articles by this author , Pilar BahíloPilar Bahílo More articles by this author , Marta TrassierraMarta Trassierra More articles by this author , and Francisco BoronatFrancisco Boronat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.576AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the efficiency, in terms of cost-effectiveness, and safety of increasing focal shock wave energy through an expanded number of shockwaves per session in treating urinary lithiasis with extracorporeal lithotripsy. METHODS A randomized, prospective and comparative study was made on patients with renal or ureteral lithiasis and an indication of extracorporeal lithotripsy, between january 2011and september 2015. Two groups were studied: group A with 155 patients was subjected to a standard treatment with 3500 waves per session, and group B with 183 patients was subjected to an expanded treatment with 7000 waves per session. A Siemens Lithoskop Litotripter was used in both groups. Stone-free patients were considered after treatment when there was no lithiasis or it was expulsable (= 4mm) on radiography or non-enhanced contrast TC. The study variables were: age, gender and body mass index (BMI) of the patient, side, location, size and Hounsfield Units (HU) of the stone, number of waves per session, total waves applied to resolution, number of sessions required, stone-free rate (SFR), and major and minor complication rate (Clavien-Dindo classification). The data of the global expenditure was extracted from the hospital's economic information department. A decision tree analysis was modelled for each alternative. Using this model, we estimated the incremental cost effectiveness ratio (ICER) and we conducted a Monte Carlo Simulation for a probabilistic sensitivity analysis RESULTS Both groups were comparable in terms of age, gender and BMI of the patient, side, HU, location and size of lithiasis. The global SFR was 71% and 86,3% in groups A and B respectively (p=0.001). There were no differences in the complication rate (26,5% vs 26,2%, p=0,9) and severity between the two groups, neither in renal damage indicators. The average cost of the SWL in group B was 1039,06 vs 1270,58 euros in group A. The estimated ICER showed that SWL with a extended number of shockwaves (group B) was dominant versus standard SWL treatment (group A). After performing the Monte Carlo simulation, the dominance of extended SWL treatment prevalied regardless of the size or location (renal or ureteral) of stone. CONCLUSIONS The increase of focal shock wave energy through an expanded number of shockwaves per session in treating urinary lithiasis with extracorporeal lithotripsy is more cost-effective than standard treatment with similar safety. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e728-e729 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alberto Budía More articles by this author Vicent Caballer More articles by this author José Daniel López-Acón More articles by this author David Vivas-Consuelo More articles by this author Pilar Bahílo More articles by this author Marta Trassierra More articles by this author Francisco Boronat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...