Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis
Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis
INTRODUCTION: A rising incidence of kidney stone disease has led to an increase in ureteroscopy (URS) and shock wave lithotripsy (SWL). Our aim was to compare the cost of URS and SWL for treatment of stones.
METHODS: A systematic review and meta-analysis based on Cochrane and PRISMA standards was conducted for all studies reporting on comparative cost of treatment between URS and SWL. The cost calculation was based on factual data presented in the individual studies as reported by the authors. English language articles from January 2001 to December 2017 using Medline, PubMed, EMBASE, CINAHL, Cochrane library and Google Scholar were selected. Our study was registered with PROSPERO (International prospective register of systematic reviews)-registration number CRD 42017080350.
RESULTS: A total of 12 studies involving 2012 patients (SWL-1243, URS-769) were included after initial identification and screening of 725 studies with further assessment of 27 papers. The mean stone size was 10 and 11 mm for SWL and URS, respectively, with stone location in the proximal ureter (n = 8 studies), distal ureter (n = 1), all locations in the ureter (n = 1) and in the kidney (n = 2). Stone free rates (84 vs. 60%) were favourable for URS compared to SWL (p < 0.001). Complication rates (23 vs. 30%) were non-significantly in favor of SWL (p = 0.11) whereas re-treatment rates (11 vs. 27%) were non-significantly in favor of URS (p = 0.29). Mean overall cost was significantly lower for URS ($2801) compared to SWL ($3627) (p = 0.03). The included studies had high risk of bias overall. On sub-analysis, URS was significantly cost-effective for both stones < 10 and ≥ 10 mm and for proximal ureteric stones.
CONCLUSION: There is limited evidence to suggest that URS is less expensive than SWL. However, due to lack of standardization, studies seem to be contradictory and further randomized studies are needed to address this issue.
Adult, Aged, Cost-Benefit Analysis, Female, Humans, Lithotripsy/economics, Male, Middle Aged, Treatment Outcome, Ureteral Calculi/diagnostic imaging, Ureteroscopy/economics
1783-1793
Geraghty, Robert M.
65977705-49f3-48b7-8a80-a86c26955755
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Herrmann, Thomas R.W.
870f9c6b-7dd3-4344-beaa-f591ffef12bf
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
November 2018
Geraghty, Robert M.
65977705-49f3-48b7-8a80-a86c26955755
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Herrmann, Thomas R.W.
870f9c6b-7dd3-4344-beaa-f591ffef12bf
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Geraghty, Robert M., Jones, Patrick, Herrmann, Thomas R.W., Aboumarzouk, Omar and Somani, Bhaskar K.
(2018)
Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis.
World Journal of Urology, 36 (11), .
(doi:10.1007/s00345-018-2320-9).
Abstract
INTRODUCTION: A rising incidence of kidney stone disease has led to an increase in ureteroscopy (URS) and shock wave lithotripsy (SWL). Our aim was to compare the cost of URS and SWL for treatment of stones.
METHODS: A systematic review and meta-analysis based on Cochrane and PRISMA standards was conducted for all studies reporting on comparative cost of treatment between URS and SWL. The cost calculation was based on factual data presented in the individual studies as reported by the authors. English language articles from January 2001 to December 2017 using Medline, PubMed, EMBASE, CINAHL, Cochrane library and Google Scholar were selected. Our study was registered with PROSPERO (International prospective register of systematic reviews)-registration number CRD 42017080350.
RESULTS: A total of 12 studies involving 2012 patients (SWL-1243, URS-769) were included after initial identification and screening of 725 studies with further assessment of 27 papers. The mean stone size was 10 and 11 mm for SWL and URS, respectively, with stone location in the proximal ureter (n = 8 studies), distal ureter (n = 1), all locations in the ureter (n = 1) and in the kidney (n = 2). Stone free rates (84 vs. 60%) were favourable for URS compared to SWL (p < 0.001). Complication rates (23 vs. 30%) were non-significantly in favor of SWL (p = 0.11) whereas re-treatment rates (11 vs. 27%) were non-significantly in favor of URS (p = 0.29). Mean overall cost was significantly lower for URS ($2801) compared to SWL ($3627) (p = 0.03). The included studies had high risk of bias overall. On sub-analysis, URS was significantly cost-effective for both stones < 10 and ≥ 10 mm and for proximal ureteric stones.
CONCLUSION: There is limited evidence to suggest that URS is less expensive than SWL. However, due to lack of standardization, studies seem to be contradictory and further randomized studies are needed to address this issue.
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Accepted/In Press date: 30 April 2018
e-pub ahead of print date: 5 May 2018
Published date: November 2018
Keywords:
Adult, Aged, Cost-Benefit Analysis, Female, Humans, Lithotripsy/economics, Male, Middle Aged, Treatment Outcome, Ureteral Calculi/diagnostic imaging, Ureteroscopy/economics
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Local EPrints ID: 433450
URI: http://eprints.soton.ac.uk/id/eprint/433450
ISSN: 0724-4983
PURE UUID: d3a2648a-151e-46c4-a239-36ee2be13fd1
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Date deposited: 22 Aug 2019 16:30
Last modified: 16 Mar 2024 03:24
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Author:
Robert M. Geraghty
Author:
Patrick Jones
Author:
Thomas R.W. Herrmann
Author:
Omar Aboumarzouk
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