PURPOSE: We evaluated the cost-effectiveness of anti-retropulsion devices used during ureteroscopic lithotripsy.
MATERIALS AND METHODS: A decision analysis model was constructed to compare the cost-effectiveness of ureteroscopic lithotripsy with vs without an anti-retropulsion device. The risk of stone retropulsion was determined from published data in the English language literature. Expected value calculations were used to determine whether the additional cost of a device would be cost-effective to prevent secondary procedures used to treat retropulsed stones. Device cost was determined using the average cost of all commercially available devices.
RESULTS: It became cost-effective to use an anti-retropulsion device at or above a 6.3% retropulsion rate. The weighted probability of retropulsion with vs without an anti-retropulsion device was 98.1% vs 83.7%. The estimated costs of secondary procedures needed to treat retropulsed stones were $5,290 for shock wave lithotripsy and $6,390 for ureteroscopy. Average device cost was $278. Thus, the average additional cost of ureteroscopic lithotripsy with vs without an anti-migration device would be $384 vs $952.
CONCLUSIONS: It is cost-effective to use an anti-retropulsion device at a retropulsion rate of greater than 6.3%.
Written by:
Ursiny M, Eisner BH. Are you the author?
Kidney Stone Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Reference: J Urol. 2012 Nov 15. pii: S0022-5347(12)05589-9.
doi: 10.1016/j.juro.2012.11.085
PubMed Abstract
PMID: 23159589
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