Cost-Effectiveness Comparison of Renal Calculi Treated with Ureteroscopic Laser Lithotripsy Versus Shockwave Lithotripsy

Purpose: To evaluate the cost-effectiveness of shockwave lithotripsy (SWL) vs ureteroscopic lithotripsy (URS) for patients with renal stones < 1.5 cm in diameter. Methods: Patient age, stone diameter, stone location, and stone-free status were recorded for patients treated with SWL or URS for renal stones < 1.5 cm in maximal diameter over a 1-year period. Institutional charges were obtained from in-house billing. A decision analysis model was constructed to compare the cost-effectiveness of SWL and URS and using our results and success rates for modeling. Three separate models were created to reflect practice patterns for SWL. Results: One hundred fifty-eight patients were included in the study-78 underwent SWL and 80 underwent URS as primary treatment. Single procedure stone-free rates (SFR) for SWL and URS were 55% and 95%, respectively (P < 0.0001). Decision analysis modeling demonstrated cost-effectiveness of SWL when SWL single procedure SFR were 65% to 67% or when URS single procedure SFR was 72% to 84%. Conclusions: This retrospective study revealed superior SFR results for renal stones < 1.5 cm for URS compared with SWL. Our decision analysis model demonstrates that for SWL SFR less than 65% to 67% or for URS SFR greater than 72% to 84%, SWL is not a cost-effective treatment option. Based on these findings, careful stratification and selection of stone patients may enable surgeons to increase the cost-effectiveness of SWL.