Lotan Yair
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
Adv Chronic Kidney Dis. 2009 Jan;16(1):5-10. doi: 10.1053/j.ackd.2008.10.002.
Nephrolithiasis is associated with a high cost to society because of the high prevalence of disease and high recurrence rates. The total annual medical expenditures for urolithiasis in the United States were estimated at $2.1 billion in 2000. The cost of stone disease reflects the cost of health care services required to manage stone disease and the rate of utilization. Although the care of individuals with urolithiasis has shifted from the inpatient to the outpatient setting and the hospital length of stay has decreased, costs continue to rise because of increases in the prevalence of kidney stones. There are 2 potential areas that would allow for a decrease in stone disease-related costs, lower health care-related costs, and decreased prevalence of stone disease. Reducing treatment-related costs are unlikely to provide a solution to the high cost of caring for stone disease because physician-fee reductions did not result in a significant reduction in costs. Furthermore, there are no significant advancements in surgical technique or technologies in the horizon. One area of cost savings could be to develop better guidelines for acute management, optimizing timing for surgery in acute settings and increasing the practice of medical expulsive therapy. Another area with potential to reduce costs is the reduction of overall stone burden through the prevention of new stones or recurrences. Strategies for primary prevention in high-risk populations have not been studied and represent an area for future research. More efforts should be made to improve medical management of stone formers. These efforts include improving dietary recommendations, identifying barriers to evaluations and treatment of recurrent stone formers, improving patient compliance with recommendations, and development of new medications.
由于肾结石病的高发病率和高复发率，它给社会带来了高昂的成本。2000年，美国尿石症的年度医疗总支出估计为21亿美元。结石病的成本反映了管理结石病所需的医疗保健服务成本和利用率。尽管肾结石患者的护理已从住院转向门诊，住院时间也有所缩短，但由于肾结石患病率的上升，成本仍在持续增加。有两个潜在领域可以降低与结石病相关的成本、降低医疗保健相关成本并降低结石病的患病率。降低治疗相关成本不太可能解决治疗结石病的高昂成本问题，因为降低医生费用并未导致成本显著降低。此外，短期内手术技术或技术方面也没有重大进展。一个节省成本的领域可能是制定更好的急性管理指南，优化急性情况下的手术时机，并增加药物排石疗法的应用。另一个有可能降低成本的领域是通过预防新结石或复发来减轻总体结石负担。高危人群的一级预防策略尚未得到研究，是未来研究的一个领域。应该做出更多努力来改善结石患者的医疗管理。这些努力包括改进饮食建议、识别复发性结石患者评估和治疗的障碍、提高患者对建议的依从性以及开发新药物。
