Is medical dissolution treatment for uric acid stones more cost-effective than surgical treatment? A novel, solo practice, retrospective cost-analysis of medical vs. surgical therapy

Authors

  • Amihay Nevo University Hospitals Cleveland Medical Center - Urology Institute
  • Mitchell R. Humphreys Mayo Clinic Arizona - Department of Urology
  • Michael Callegari University Hospitals Cleveland Medical Center - Urology Institute
  • Mira Keddis Mayo Clinic Arizona - Department of Nephrology
  • Jonathan P. Moore Mayo Clinic Arizona - Department of Urology
  • Saif Salih Mayo Clinic Arizona - Department of Urology
  • Karen L. Stern Mayo Clinic Arizona - Department of Urology

DOI:

https://doi.org/10.5489/cuaj.7833

Keywords:

nephrolithiasis, uric acid, dissolution, cost-effectiveness

Abstract

Introduction: Effective medical dissolution therapy (MDT) for uric acid stones is more cost-effective than surgical treatment; however, treatment failure may be associated with increased cost. We aimed to study the cost-effectiveness of MDT for uric acid stones vs. surgical management.

Methods: We performed a retrospective study within our institution of all patients receiving MDT for uric acid stones from 2008–2019. All patients had a known history of uric acid stones, urine pH ≤5.5, and <500 Hounsfield units on preoperative computed tomography (CT). The cost of treatment in the dissolution group was compared to the cost of primary surgical treatment in a theoretical matched cohort. Cost was estimated using local Medicare reimbursement scales. Statistical analysis was performed with SPSS Statistics.

Results: A total of 28 patients were identified, of which 18 were included in the study. Complete and partial dissolution occurred in six (33%) and four (22%) patients, respectively. Five (28%) patients developed symptoms and underwent ureteral stent placement. Ureteroscopy and percutaneous nephrolithotomy (PCNL) were each performed in three (17%) patients in whom dissolution treatment was not effective on followup CT. Following dissolution trial, six (33%) patients had residual stone burden requiring surgical intervention. The average cost of treatment, including surgeries, was $14 604 in the dissolution group vs. $17 680 in the surgical cohort. The average cost to achieve stone-free status in patients with complete, partial, or no response to dissolution were $1675, $10 124, and $21 584, respectively, while primary surgical treatment for the same patients would cost $15 037, $10 901, and $20 511, respectively.

Conclusions: Successful MDT is highly cost-effective. Incomplete response to dissolution can stem from several reasons and contributes to higher costs and likely decreased quality of life.

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Published

2022-08-30

How to Cite

Nevo, A., Humphreys, M. R., Callegari, M., Keddis, M., Moore, J. P., Salih, S., & Stern, K. L. (2022). Is medical dissolution treatment for uric acid stones more cost-effective than surgical treatment? A novel, solo practice, retrospective cost-analysis of medical vs. surgical therapy. Canadian Urological Association Journal, 17(1), E29–34. https://doi.org/10.5489/cuaj.7833

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Section

Original Research