PUK33 - COMPARISON OF TREATMENT PATTERN IN UROLITHIASIS : A POPULATION STUDY USING KOREAN HEALTH INSURANCE REVIEW AND ASSESSMENT SERVICE DATABASE

Abstract

According to the current guideline for urolithiasis, Extracorporeal Shock Wave Lithotripsy (ESWL), which is non-invasive and convenient, is recommended as first-line treatment when the stone size is less than 10mm or stone larger than 10mm is located in the proximal ureter. If not in these cases, other invasive treatments, such as Retrograde Intrarenal Surgery (RIRS), Percutaneous Nephrolithotomy (PCNL), or Ureteroscopic Lithotripsy (URSL), should be considered. So far, a few studies has evaluated outcomes of each treatment for urolithiasis in the real-world. This study assessed treatment patterns among urolithiasis patients using claim data. Using the Korean Health Insurance Review and Assessment Service (HIRA) database, we recruited patients who were diagnosed with urinary stones and had undergone urolithiasis treatments in 2016, excluding those with the history of urolithiasis treatments within 6 months. Claim data for 6 months, defined as a single episode, after the initial treatment were analyzed. Among 96,863 patients, 87,844 (90.7%), 916 (0.9%), 1,055 (1.1%), 7,048 (7.3%) were initially treated with ESWL, RIRS, PCNL, and URSL, respectively. Of the patients who underwent ESWL first, 61.4% were treated in the clinics, while other treatments were performed mostly at hospitals. ESWL showed the lowest success rate for initial treatment (67.7% for ESWL; 90.8% for RIRS; 84.1% for PCNL; 94.9% for URSL; p<0.0001). The total number of treatments per one episode was highest in patients initially treated with ESWL (2.49 for ESWL; 1.14 for RIRS; 1.32 for PCNL; 2.08 for URSL; p<0.0001). Among patients initially treated with ESWL, 86.4% received treatments for the maximum twice per episode, which means that 13.4% still had to undergo retreatments because of repeated failure. ESWL, largely performed in the clinic, has lower success rate than other treatments and requires several retreatments. Physicians should precisely assess patients’ status beforehand to decide appropriate treatment which best fits for them.