Stone Treatment Centre, Craigavon Area Hospital, Portadown, Northern Ireland, UK.
BJU Int. 2011 Dec;108(11):1913-6. doi: 10.1111/j.1464-410X.2011.10172.x. Epub 2011 Mar 31.
What's known on the subject? and What does the study add? Stone management economics is a complex issue. FURS and SWL are recognised treatment option for lower pole kidney stones. There are paucity of data comparing cost implication and effectiveness of both treatment options. Both treatment modalities are equally efficacious. FURS incurred greater cost burden compared to SWL in the UK setting. In the present economic circumstance, clinicians should also consider cost-impact, patient's preference and specific clinical indication when counselling patients for treatment.
• To compare the cost-effectiveness and outcome efficiency of extracorporeal shockwave lithotripsy (SWL) vs intracorporeal flexible ureteroscopic laser lithotripsy (FURS) for lower pole renal calculi ≤20 mm.
• Patients who had treatment for their radio-opaque lower pole renal calculi were categorized into SWL and FURS group. • The primary outcomes compared were: clinical success, stone-free, retreatment and additional procedure rate, and perceived and actual costs. • Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <3 mm. • Perceived cost was defined as the cost of procedure alone, and the actual cost included the cost of additional procedures as well as the overhead costs to result in clinical success.
• The FURS (n= 37) and SWL (n= 51) group were comparable with respect to sex, age, stone size and the presence of ureteric stent. • The final treatment success rate (100% vs 100%), stone-free rate (64.9% vs 58.8%), retreatment rate (16.2% vs 21.6%) and auxillary procedure rate (21.6% vs 7.8%) did not differ significantly. • The mean perceived cost of each FURS and SWL procedure was similar (£249 vs £292, respectively); however, when all other costs were considered, the FURS group was significantly more costly (£2602 vs £426, P= 0.000; Mann-Whitney U-test).
• SWL was efficacious and cost-effective for the treatment of lower pole renal calculi ≤20 mm.
结石管理经济学是一个复杂的问题。FURS 和 SWL 是治疗下位肾结石的公认治疗选择。比较两种治疗方案的成本影响和有效性的数据很少。两种治疗方式同样有效。在英国，FURS 的成本负担比 SWL 高。在当前的经济环境下，临床医生在为患者提供治疗建议时，还应考虑成本影响、患者的偏好和具体的临床指征。
比较体外冲击波碎石术（SWL）与腔内软镜激光碎石术（FURS）治疗≤20mm 下极肾结石的成本效益和结果效率。
将接受治疗的放射性不透光下极肾结石患者分为 SWL 和 FURS 组。比较的主要结果是：临床成功率、结石清除率、再治疗率和附加手术率，以及感知成本和实际成本。临床成功率定义为结石清除状态或无症状的无意义残留碎片<3mm。感知成本定义为手术费用，实际成本包括附加手术费用以及导致临床成功的间接费用。
FURS（n=37）和 SWL（n=51）组在性别、年龄、结石大小和输尿管支架存在方面具有可比性。最终治疗成功率（100% vs 100%）、结石清除率（64.9% vs 58.8%）、再治疗率（16.2% vs 21.6%）和辅助手术率（21.6% vs 7.8%）无显著差异。FURS 和 SWL 手术的平均感知成本相似（分别为 249 英镑和 292 英镑）；然而，当考虑所有其他成本时，FURS 组的成本显著更高（2602 英镑 vs 426 英镑，P=0.000；Mann-Whitney U 检验）。
SWL 是治疗≤20mm 下极肾结石的有效且具有成本效益的方法。
