Relative costs and cost-effectiveness of extracorporeal shock-wave lithotripsy versus percutaneous nephrolithotomy in the treatment of renal and ureteric stones.

This paper presents empirical data from the United Kingdom National Health Service on the comparative mean hospital costs per patient of first generation extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCN) in the treatment of kidney stones. These results were subjected to a sensitivity analysis and related to evidence on the health effects of the two approaches to treatment. The hospital costs of PCN were found to be lower than for ESWL in the empirical comparison and in most but not all the scenarios developed in the sensitivity analysis. The direction of the comparison was reversed when a high throughput was assumed for ESWL and a significantly higher per diem cost for PCN than ESWL. The relative cost-effectiveness of the two modes of treatment depended on whether successful treatment was defined in terms of rendering the patient free of stones (the traditional endpoint of treatment) or the rate at which patients returned to their normal activities.