Primary ureteroscopy versus ureteric stenting in the emergency setting: a cost-effectiveness analysis
BAUS ePoster online library. Sehgal R. 06/23/21; 319053; p14-5
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Radha Sehgal
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Abstract
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Introduction
Nephrolithiasis represents a significant economic burden worldwide, yet there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a cost-effectiveness analysis between primary treatment and ureteric stenting in patients with ureteric stones in the emergency setting.
Patients and Methods
We conducted a retrospective analysis of patients requiring emergency intervention for a ureteric calculus at our institution between January and December 2019. Secondary care cost (SCC) was calculated to include cost of the intervention, inpatient bed days, emergency department (A&E) attendances, additional procedures such as nephrostomy and secondary definitive procedure.
Results
A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), to include primary URS (34%) and shock wave lithotripsy (3.6%).
Those undergoing primary treatment had significantly less A&E reattendances (10.9% vs 25.7%, p=0.02). SCC was greater in the stenting group (£4485.42 vs £3536.83; p = 0.65). The cost-per-patient related to A&E reattendances was significantly higher in the stenting group (£61.05 vs £20.87; p < 0.001).
Conclusions
Performing primary treatment in patients presenting with acute ureteric colic may infer a cost benefit, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.
Nephrolithiasis represents a significant economic burden worldwide, yet there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a cost-effectiveness analysis between primary treatment and ureteric stenting in patients with ureteric stones in the emergency setting.
Patients and Methods
We conducted a retrospective analysis of patients requiring emergency intervention for a ureteric calculus at our institution between January and December 2019. Secondary care cost (SCC) was calculated to include cost of the intervention, inpatient bed days, emergency department (A&E) attendances, additional procedures such as nephrostomy and secondary definitive procedure.
Results
A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), to include primary URS (34%) and shock wave lithotripsy (3.6%).
Those undergoing primary treatment had significantly less A&E reattendances (10.9% vs 25.7%, p=0.02). SCC was greater in the stenting group (£4485.42 vs £3536.83; p = 0.65). The cost-per-patient related to A&E reattendances was significantly higher in the stenting group (£61.05 vs £20.87; p < 0.001).
Conclusions
Performing primary treatment in patients presenting with acute ureteric colic may infer a cost benefit, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.
Introduction
Nephrolithiasis represents a significant economic burden worldwide, yet there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a cost-effectiveness analysis between primary treatment and ureteric stenting in patients with ureteric stones in the emergency setting.
Patients and Methods
We conducted a retrospective analysis of patients requiring emergency intervention for a ureteric calculus at our institution between January and December 2019. Secondary care cost (SCC) was calculated to include cost of the intervention, inpatient bed days, emergency department (A&E) attendances, additional procedures such as nephrostomy and secondary definitive procedure.
Results
A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), to include primary URS (34%) and shock wave lithotripsy (3.6%).
Those undergoing primary treatment had significantly less A&E reattendances (10.9% vs 25.7%, p=0.02). SCC was greater in the stenting group (£4485.42 vs £3536.83; p = 0.65). The cost-per-patient related to A&E reattendances was significantly higher in the stenting group (£61.05 vs £20.87; p < 0.001).
Conclusions
Performing primary treatment in patients presenting with acute ureteric colic may infer a cost benefit, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.
Nephrolithiasis represents a significant economic burden worldwide, yet there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a cost-effectiveness analysis between primary treatment and ureteric stenting in patients with ureteric stones in the emergency setting.
Patients and Methods
We conducted a retrospective analysis of patients requiring emergency intervention for a ureteric calculus at our institution between January and December 2019. Secondary care cost (SCC) was calculated to include cost of the intervention, inpatient bed days, emergency department (A&E) attendances, additional procedures such as nephrostomy and secondary definitive procedure.
Results
A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), to include primary URS (34%) and shock wave lithotripsy (3.6%).
Those undergoing primary treatment had significantly less A&E reattendances (10.9% vs 25.7%, p=0.02). SCC was greater in the stenting group (£4485.42 vs £3536.83; p = 0.65). The cost-per-patient related to A&E reattendances was significantly higher in the stenting group (£61.05 vs £20.87; p < 0.001).
Conclusions
Performing primary treatment in patients presenting with acute ureteric colic may infer a cost benefit, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.
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