台北市立医院治疗输尿管结石的成本效益：冲击波碎石术与输尿管镜检查联合碎石器治疗的比较

Cost-effectiveness of treating ureteral stones in a Taipei City Hospital: shock wave lithotripsy versus ureteroscopy plus lithoclast.

作者信息

Huang Chi-Yi, Chen Shiou-Sheng, Chen Li-Kuei

机构信息

Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

Urol Int. 2009;83(4):410-5. doi: 10.1159/000251180. Epub 2009 Dec 8.

DOI:10.1159/000251180

PMID:19996647

Abstract

AIM

To compare cost-effectiveness, success rates and sat isfaction score of ureteroscopic lithotripsy with lithoclast (URSL) and extracorporeal shock wave lithotripsy (ESWL) for ureteral stones in a Taipei City Hospital.

METHODS

This is a retrospective study. From July 1998 to June 2000, 448 patients who underwent treatment for ureteral stones were included. The patients were divided into two treatment groups according to the initial method adopted for the management of their stone. Medical records and hospital financial records were collected for costs of implementing each treatment program. The satisfaction scores of patients (rating from 0 to 10) were collected by telephone interviews. Success was defined as complete clearance of the stone or fragmentation of stones smaller than 2 mm by plain abdominal film and complete relief of symptoms after initial treatment.

RESULTS

A total of 360 patients were in the ESWL group (including 144 upper, 48 middle and 168 lower third stones) and 88 in the URSL group (including 28 upper, 24 middle and 36 lower third stones). The range of stone size was from 0.6 to 1.9 cm. The overall treatment cost was comparable in both groups with a trend for it to be higher in the ESWL group without reaching statistical significance (TWD 20,901.5 +/- 8,911.3 vs. 19,876.1 +/- 4,782.2). Stratified by the location of stone, the overall treatment cost was significantly higher in the ESWL group than in the URSL group for patients with upper third ureteral stones irrespective of stone size. The efficiency quotient for ESWL and URSL was 0.62 and 0.65, respectively. The success rate was significantly higher in the URSL group than in the ESWL group (89.8 vs. 71.7%). Satisfaction scores were similar for both groups with a trend to be higher in the ESWL group without reaching statistical significance (7.97 +/- 1.01 vs. 7.53 +/- 1.37).

CONCLUSIONS

The overall treatment cost of patients with upper third ureteral stone was significantly higher in the ESWL group than in the URSL group, but the success rate was significantly higher in the URSL group than in the ESWL group.

摘要

目的

比较台北市某医院输尿管镜气压弹道碎石术（URSL）和体外冲击波碎石术（ESWL）治疗输尿管结石的成本效益、成功率和满意度评分。

方法

这是一项回顾性研究。纳入1998年7月至2000年6月间448例接受输尿管结石治疗的患者。根据结石治疗所采用的初始方法将患者分为两个治疗组。收集病历和医院财务记录以获取实施每个治疗方案的成本。通过电话访谈收集患者的满意度评分（0至10分）。成功定义为结石完全清除或经腹部平片显示结石碎至小于2mm且初始治疗后症状完全缓解。

结果

ESWL组共360例患者（包括上段结石144例、中段结石48例和下段结石168例），URSL组88例患者（包括上段结石28例、中段结石24例和下段结石36例）。结石大小范围为0.6至1.9cm。两组的总体治疗成本相当，ESWL组有成本更高的趋势，但未达到统计学显著性（新台币20,901.5 +/- 8,911.3 vs. 19,876.1 +/- 4,782.2）。按结石位置分层，无论结石大小，ESWL组上段输尿管结石患者的总体治疗成本显著高于URSL组。ESWL和URSL的效率商分别为0.62和0.65。URSL组的成功率显著高于ESWL组（89.8%对71.7%）。两组的满意度评分相似，ESWL组有评分更高的趋势，但未达到统计学显著性（7.97 +/- 1.01对7.53 +/- 1.37）。