Lotan Yair, Cadeddu Jeffrey A, Roerhborn Claus G, Pak Charles Y C, Pearle Margaret S
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
J Urol. 2004 Dec;172(6 Pt 1):2275-81. doi: 10.1097/01.ju.0000141498.11720.20.
We evaluated the cost-effectiveness and stone recurrence rates of common management strategies in stone formers.
A decision tree model was created to compare the costs of 6 medical treatment strategies, namely dietary measures alone (conservative), empiric drug treatment (empiric), or directed drug therapy based on simple or comprehensive metabolic evaluation. The model assumed cost accrual for evaluation, medications, emergency treatment and surgery for stone recurrence. We determined recurrence rates, medical evaluation sensitivity and the risk reduction of medical treatments from the literature and the costs of surgery, emergency room and medical evaluation at our county hospital. Drug costs were obtained from 2 national pharmacy chains.
In first time stone formers conservative treatment was the least costly strategy and it yielded a stone formation rate of 0.07 stones per patient yearly. In recurrent stone formers conservative treatment was less costly than drug treatments but it was associated with a higher stone recurrence rate (0.3 stones per patient yearly). The remaining drug treatments were more costly than conservative treatment ($885 to 1,187 vs $258 yearly) but they further decreased recurrence rates by 60% to 86%. Modified simple medical evaluation and management (SMEM), that is drug treatment in all patients after simple evaluation) was slightly more costly than empiric treatment and minimally more effective. Comprehensive evaluation and treatment offered no advantage in cost or efficacy over empiric treatment or modified SMEM.
In first time stone formers conservative therapy is cost-effective and efficacious. In recurrent stone formers conservative therapy is unsatisfactory despite low cost because of a high recurrence rate. Modified SMEM and empiric therapy yield the same cost and efficacy as treatments that follow comprehensive evaluation. However, modified SMEM may be advantageous because it offers useful additional medical information.
我们评估了结石患者常见治疗策略的成本效益和结石复发率。
创建了一个决策树模型，以比较6种医学治疗策略的成本，即单纯饮食措施（保守治疗）、经验性药物治疗（经验治疗）或基于简单或全面代谢评估的针对性药物治疗。该模型假定评估、药物治疗、急诊治疗和结石复发手术的成本累积。我们从文献中确定了复发率、医学评估敏感性和医学治疗的风险降低情况，以及我们县医院的手术、急诊室和医学评估成本。药物成本来自两家全国性连锁药店。
在初发结石患者中，保守治疗是成本最低的策略，每年每位患者的结石形成率为0.07颗。在复发性结石患者中，保守治疗的成本低于药物治疗，但结石复发率较高（每年每位患者0.3颗）。其余药物治疗的成本高于保守治疗（每年885美元至1187美元对258美元），但它们进一步将复发率降低了60%至86%。改良的简单医学评估与管理（SMEM，即简单评估后对所有患者进行药物治疗）比经验治疗成本略高，效果略好。综合评估与治疗在成本或疗效方面并不优于经验治疗或改良的SMEM。
在初发结石患者中，保守治疗具有成本效益且有效。在复发性结石患者中，尽管成本低，但由于复发率高，保守治疗并不令人满意。改良的SMEM和经验治疗与综合评估后的治疗具有相同的成本和疗效。然而，改良的SMEM可能具有优势，因为它提供了有用的额外医学信息。
