PUK20 - COST-UTILITY ANALYSIS OF EXTRACORPOREAL LITHOTRIPSY VERSUS URETERORENOSCOPY-HOLMIUM LASER FOR TREATMENT OF URINARY STONES

Abstract

The objective od this study is to compare the cost-utility profile of ureterorenoscopy-holmium laser (URS) versus extracorporeal lithotripsy (ESWL) in the treatment of urinary stones smaller than 20mm. A total of 525 patients treated between 2012-2014 were included in the study. Of these, 229 (43.6%) were treated with URS and 296 (56.3%) with ESWL. For QALYs calculation, a sample of 78 patients (32 treated with ESWL and 46 with URS) were evaluated prospectively (January 2016-December 2016) using a quality of life survey (Euroqol 5QD-3L) before and after treatment. A Markov model (SWL + URS salvage vs primary URS) was constructed for the calculation of the quality of life in each possible state of the patient (lithiasis without double J stent, lithiasis with stent, free of lithiasis without stent and free of lithiasis with stent). A Monte Carlo simulation was performed as probabilistic sensitivity analysis to confirm the robustness of the results. Of the 525 patients, 345 (65.71%) were treated for renal lithiasis (41.7% by URS and 58.26% by SWL) and 180 for ureteral lithiasis (47.2% by URS and 52.7% by ESWL). Mean cost per patient treated with ESWL and URS 1.733,96 € and 2.337,31 € euros respectively. Renal stone-free rate was 91.7% for URS and 79.16% for ESWL and ureteral stone-free rate was 94% and 81%, respectively. The cost-utility analysis showed higher cost but incremental QALYS of 0.011 for URS, thus, the ICER was 50.829,82 €/QUALY, above the acceptability threshold. According to our results, ESWL showed to be a more efficient tool in cost-utility terms compared to URS in the treatment of reno-ureteral lithiasis smaller than 20 mm.