PMID- 31663246
OWN - NLM
STAT- MEDLINE
DCOM- 20200730
LR  - 20200730
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 125
IP  - 3
DP  - 2020 Mar
TI  - Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy 
      (ESWL) in the management of ureteric stones <10 mm in adults: a UK perspective.
PG  - 457-466
LID - 10.1111/bju.14938 [doi]
AB  - OBJECTIVES: To compare the total cost of a treatment strategy starting with 
      ureteroscopy (URS) vs a strategy starting with extracorporeal shockwave 
      lithotripsy (ESWL). METHODS: For ureteric stones of <10 mm, URS or ESWL are the 
      main treatment options that are considered. Although the interventions differ, 
      the goal of the interventions is to achieve a stone-free status. A systematic 
      review and meta-analysis undertaken as part of the National Institute for Health 
      and Care Excellence (NICE) guideline on 'Renal and ureteric stones: assessment 
      and management' identified URS as more effective, in terms of getting people 
      stone free, but has a higher probability of re-admission and adverse events (AEs) 
      that contributes to downstream resource use. ESWL is initially less costly, but 
      lower effectiveness means a greater need for repeat or ancillary procedures in 
      order to get a patient stone free. Given these trade-offs between benefits and 
      costs, a cost analysis of URS and ESWL was undertaken as part of the NICE 
      guideline, using evidence from the literature of effectiveness, re-admission and 
      AEs. The NICE guideline meta-analysis showed a lot of heterogeneity and 
      differences in how outcomes were reported between studies. The costing analysis, 
      therefore only used studies where: (i) patients were rendered stone free, and 
      (ii) where effectiveness, was based on the first-line (initial) procedures. 
      Exploratory quality adjusted life year (QALY) work was also undertaken to 
      identify the QALY and quality of life (QoL) differences required for the most 
      expensive intervention to be cost effective, based on the assumption that the 
      difference in effectiveness between the initial procedures would be the main 
      source of the QALY gain between the two strategies. RESULTS: The URS strategy was 
      more costly overall than the ESWL strategy (incremental cost of  pound2387 [pounds 
      sterling]). Sensitivity analysis varying the initial effectiveness of ESWL 
      treatment (between the base case value of 82% and 40%) showed that URS would 
      still be a more costly strategy even if the initial session of ESWL only had a 
      success probability of 40%. A two-way sensitivity analysis as part of the 
      exploratory QALY work showed that ESWL would have to have very low effectiveness 
      and people would have to wait for further treatment for many weeks (following a 
      failed ESWL treatment) for there to be feasible QoL gains to justify the 
      additional cost of the URS strategy. CONCLUSIONS: ESWL is less effective at 
      initial stone clearance and therefore requires more ancillary interventions than 
      URS. However, the magnitude of the difference in costs means URS is unlikely to 
      be cost effective intervention at a population level for first-line treatment, 
      implying ESWL should be the first choice treatment.
CI  - (c) 2019 The Authors BJU International (c) 2019 BJU International Published by John 
      Wiley & Sons Ltd.
FAU - Constanti, Margaret
AU  - Constanti M
AUID- ORCID: 0000-0002-0161-7980
AD  - National Guideline Centre, London, UK.
FAU - Calvert, Robert C
AU  - Calvert RC
AD  - Department of Urology, Royal Liverpool University Hospital, Liverpool, UK.
FAU - Thomas, Kay
AU  - Thomas K
AD  - Stone Unit, Guys and St Thomas' NHS Foundation Trust, London, UK.
FAU - Dickinson, Andrew
AU  - Dickinson A
AD  - Department of Urology, University Hospitals Plymouth, Plymouth, UK.
FAU - Carlisle, Sophie
AU  - Carlisle S
AD  - University of Nottingham, Nottingham, UK.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20191202
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - *Costs and Cost Analysis
MH  - Humans
MH  - Lithotripsy/*economics
MH  - United Kingdom
MH  - Ureteral Calculi/pathology/*therapy
MH  - Ureteroscopy/*economics
OTO - NOTNLM
OT  - #UroStone
OT  - ESWL
OT  - cost
OT  - quality of life
OT  - ureteroscopy
EDAT- 2019/10/31 06:00
MHDA- 2020/07/31 06:00
CRDT- 2019/10/31 06:00
PHST- 2019/10/31 06:00 [pubmed]
PHST- 2020/07/31 06:00 [medline]
PHST- 2019/10/31 06:00 [entrez]
AID - 10.1111/bju.14938 [doi]
PST - ppublish
SO  - BJU Int. 2020 Mar;125(3):457-466. doi: 10.1111/bju.14938. Epub 2019 Dec 2.