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Minimizing the Cost of Treating Asymptomatic Ureterolithiasis
Lamberts RW, Lines E, Conti SL, Leppert JT, Elliott CS. Minimizing the Cost of Treating Asymptomatic Ureterolithiasis. Urology practice. 2018 May 1; 5(3):172-179.
Introduction: Treatment of patients with ureterolithiasis who report resolution of their symptoms
but do not recall passing the stone presents a clinical challenge. We analyzed the cost of different
therapeutic strategies for these patients.
Methods: We performed a cost minimization analysis using published efficacy data and Medicare
reimbursement costs. We compared 1) up-front ureteroscopy with planned lithotripsy, 2) followup
imaging to determine presence or absence of stone using computerized tomography, abdominal
plain film or ultrasound and 3) observation. We performed sensitivity analyses on the factors
driving cost, including the probability of stone passage and ultrasound sensitivity.
Results: Observation was associated with the lowest costs for patients likely to spontaneously pass
the ureteral stone (greater than 62%). Initial imaging with computerized tomography was the least
costly approach for patients with an intermediate probability of stone passage (21% to 62%). When
the sensitivity of ultrasound was modeled to be high (greater than 79%), it surpassed computerized
tomography as the least costly approach across a wide range of spontaneous passage rates. Ureteroscopy
was associated with the lowest costs when the probability of spontaneous stone passage
was low (less than 21%).
Conclusions: The probability of spontaneous passage of a ureteral stone can be used to optimize
treatment strategies for patients. Observation minimizes costs for patients with stones likely to pass
spontaneously, whereas ureteroscopy minimizes costs for stones unlikely to pass. For ureteral
stones with an intermediate probability of spontaneous passage computerized tomography to guide
treatment is associated with the lowest estimated costs.