Category: Epidemiology, Health Policy, Socioeconomics & Outcomes

MP28-22 - Cost-Effectiveness of Dusting vs. Basketing Intrarenal Stones

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

To assess the cost-effectiveness of ureteroscopic laser fragmentation techniques for the treatment of renal stones using a decision analysis model.


Methods :

Outcomes data from a prospective trial of “dusting” versus “basketing” trial performed by the EDGE consortium were utilized. A decision analysis model was constructed to compare the cost-effectiveness of two methods of ureteroscopic lithotripsy: dusting stones completely versus fragmentation with basket removal. For basketing procedure costs, a basket, ureteral stent, and ureteral access sheath were used for each procedure; for dusting costs, a ureteral stent was used in 16% of procedures and there was no basket use. Expected value calculations with Markov modeling and sensitivity analysis was used to determine the optimal method based on overall cost-effectiveness inclusive of equipment, time, secondary costs from complications, emergency department visits, hospital readmission, and re-interventions. Cost of operating room disposables were obtained from manufacturers. Costs of emergency department visits, readmissions, immediate and delayed re-interventions were calculated based on published figures from the literature and carried out to 3 years post-operatively.


Results :

One hundred fifty nine patients were included in the study – 84 ureteroscopy with dusting, 75 ureteroscopy with basketing. Decision analysis modeling demonstrated that on a per-procedure basis, dusting and basketing procedures had average costs of $6,324 and $7,667, respectively. The difference in cost for the 2 procedures was largely driven by differences in operative time (mean operative time for basketing = 67 min, mean operative time for dusting = 37 min). This represents an estimated savings of $1343 per procedure when using the dusting technique.


Conclusions :

Our decision analysis model demonstrates superior cost-effectiveness for ureteroscopy with dusting compared to ureteroscopy with basketing for intrarenal stones. The cost-savings are primarily due to a substantially shorter operative time. Based on these findings, careful stratification and selection of stone patients may enable surgeons to improve cost-effectiveness of ureteroscopic lithotripsy for intrarenal stones.

Michal Ursiny

Boston, Massachusetts

Alan Yaghoubian

Urologic Surgery Resident
Massachusetts General Hospital
Boston, Massachusetts

Mitchell Humphries

Phoenix, Arizona

Benjamin Chew

Vancouver, British Columbia, Canada

Manoj Monga

Head of the Endourology Unit
Cleveland Clinic Foundation
Cleveland, Ohio

Amy E. Krambeck

Professor
Indiana University School of Medicine
Indianapolis, Indiana

Roger L. Sur

Professor of Urology
UC San Diego Department of Urology
San Diego, California

Nicole L. Miller

Associate Professor of Urology
Vanderbilt University Medical Center
Nashville, Tennessee

Yui Hui Chang

Rochester, Minnesota

Bodo E. Knudsen

Director, Comprehensive Kidney Stone Program
Ohio State University
Columbus, Ohio

Brian Matlaga

Baltimore, Maryland

Ojas Shah

Professor of Urology
New York Presbyterian-Columbia University Medical Center
New York, New York

Dr. Ojas Shah is the George F. Cahill Professor of Urology at Columbia University College of Physicians and Surgeons. He also serves as the Director of the Division of Endourology and Stone Disease at Columbia University Medical Center. His clinical and research interests include surgical and metabolic treatments of kidney stone disease, minimally invasive urologic surgery, upper urinary tract urothelial carcinoma (transitional cell carcinoma), ureteral strictures, ureteropelvic junction (UPJ) obstruction, and ureteral/renal reconstructive surgery. He serves as the principal investigator in many clinical research trials regarding the surgical or medical management of stone disease.

He is a graduate of the Honors Program in Medical Education at Northwestern University School of Medicine. He completed his general surgical and urologic training at New York University Medical Center. He spent an additional year at Wake Forest University Health Sciences Center as a fellow in endourology, laparoscopy and metabolic stone disease.

Dr. Shah is a nationally and internationally recognized expert in the medical and surgical management of patients with urinary stone disease. He recently served as a member of the American Urological Association’s Surgical Management of Stones Guidelines Committee. He was also recently appointed to the American Board of Urology’s Examination Committee. He is an active member of the Endourological Society, EDGE (Endourology Disease Group for Excellence) Research Consortium, and ROCK (Research on Calculous Kinetics) Society.

Dr. Shah is an Assistant Editor for the Journal of Urology, the most highly cited and amongst the most respected international journals in the field. He is also co-editor of the 5th Edition of Taneja’s Complications of Urologic Surgery which was released in 2018.

Vernon Pais

Associate Professor, Associate Program Director
Dartmouth
Lebanon, New Hampshire

Vernon Pais is an endourologist with clinical and research focuses on urolithiasis. He is an associate professor at the Geisel School of Medicine at Dartmouth and serves as the director of urologic research and associate program director for the urology residency at Dartmouth.

Brian Eisner

Head Endourology Unit
Mass General Hospital
Needham, Massachusetts

Brian Eisner MD is Co-Director of the Kidney Stone Program at Massachusetts General Hospital, Harvard Medical School. His practices focuses on endourology and kidney stone disease