Cost Analysis of Metallic Ureteral Stents with 12 Months of Follow-Up

Background and Purpose: The metallic ureteral stent was first developed for patients with ureteral obstruction related to malignant disease, but it can be used in all patients needing chronic indwelling ureteral stents, including those with benign disease. The traditional method of polymer stent management often necessitates multiple exchanges per year depending on patient and logistical factors. This has significant direct financial cost and likely a negative effect on patients' overall health. The objective was to analyze and compare the costs associated with chronic indwelling metal and silicone-based ureteral stents. Patients and Methods: A prospective database of patients undergoing metal stent placement from February 2008 to June 2010 was reviewed. Mean charges for a single traditional nonmetal and metal stent insertion were calculated. Charges were based on direct hospital charges related to stent cost and surgery. Cost data were based on the fiscal year 2010 cost for polymer or metal stent insertions. Results: Twenty-one patients underwent metal stent placement at our institution. Of these, three traditional stent placements were omitted from analysis because of bundled charges for ureteroscopy at the same setting. Mean charges per single traditional and metal stent placement were $6072.75 and $9469.50, respectively. The estimated annual charges for traditional stents (3-6 exchanges) would be $18,218.25 to $36,436.50. Compared with metal stents, this is a potential financial savings of 48% to 74%. The mean direct cost to patients was 21.6% and 25.4% of the charges for metal and polymer stents, respectively. No patient needed early discontinuation of his or her metal stent because of lower urinatry tract symptoms or gross hematuria. Conclusions: Metal stents are well tolerated by patients with ureteral obstruction of various etiologies and provide a significant financial benefit compared with polymer ureteral stents. For patients who are not fit for surgical intervention regarding their ureteral occlusive disease, the metal Resonance stent is a financially advantageous and well-tolerated option.