PURPOSE: Evaluate economic impact of preventing recurrent stones using strategy of increased water intake and determine the impact of compliance on cost-effectiveness for French health care system.
MATERIALS AND METHOD: Markov model was constructed to compare costs and outcomes for recurrent kidney stone formers with < 2 liters/day vs. ≥2 liters/day fluid intake. Model assumptions included: annual prevalence of 120,000 stone episodes in France; 14.4% annual risk of stone recurrence; and 55% risk reduction in subjects with adequate water intake. Costs were based on resource utilization as estimated by panel of experts and official national price lists. Outcomes were from perspective of public health payer and encompassed both direct and indirect costs.
RESULTS: Total cost of episode of urolithiasis was estimated at 4,267 including cost of treatment and complications. This corresponds to an annual budget impact of 88 million for recurrent stonesbased on 21,000 stone events. Assuming 100% compliance with fluid intake recommendations of 2 liters/day, 11,572 new stones might be prevented, resulting in 49 million cost savings. Compliance with water intake in only 25% of patients would still result in 2,893 fewer stones with cost saving of 10 million.Varying cost of managing stones had smaller impact on outcomes since many patients do not make stones. Varying incidence of complications did not change the incidence of stones and had negligible effect on overall cost.
CONCLUSIONS: Preventing recurrent urolithiasis has a significant cost saving potential for a payer as a consequence of reduced stone burden. However, compliance is an important factor in determining cost-effectiveness.
Written by:
Lotan Y, Jiménez IB, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ. Are you the author?
Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX75390, USA.
Reference: J Urol. 2012 Sep 24. pii: S0022-5347(12)04971-3.
doi: 10.1016/j.juro.2012.08.254
PubMed Abstract
PMID: 23017509
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