Department of Urology, the University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
J Urol. 2011 Aug;186(2):550-5. doi: 10.1016/j.juro.2011.03.133. Epub 2011 Jun 16.
Stone disease is a highly prevalent condition associated with substantial cost and morbidity. We evaluated the cost-effectiveness of a primary prevention strategy.
A decision analysis model was constructed to compare the cost of ad hoc management of symptomatic stones vs the cost of primary prevention. A literature search was performed to determine the incidence of stone disease, the effectiveness of nonmedical prevention strategies and cost associated with stone management. One and 2-way sensitivity analyses were performed to determine conditions under which a strategy of primary prevention might be cost-effective.
Assuming a 1% incidence of stones, a 50% risk reduction and a $100 cost per individual per year for primary prevention, the model was used to calculate the overall costs per individual per year without and with a primary prevention strategy of $46 and $123, respectively. One-way sensitivity analyses indicated that primary prevention was cost-effective if the incidence of stones exceeded 4.3% yearly or the cost of prevention was less than $23 per person yearly. Varying other factors (risk reduction, probability of requiring surgery, hours of lost work, emergency room cost) failed to reach cost equivalence under any circumstances or required unrealistic assumptions. Preventive strategies were more costly than no prevention unless the incidence of stone disease was at least 1%, the cost did not exceed $20 per person per year and the prevention strategy was at least 50% effective in preventing stones.
Primary prevention strategies for stone disease have not been sufficiently evaluated but can theoretically be cost-effective if the population has a sufficiently high incidence of stone disease and the strategy is of low cost and moderately effective.
结石病是一种高发疾病，与巨大的医疗费用和发病率相关。我们评估了初级预防策略的成本效益。
构建决策分析模型，比较症状性结石的对症治疗成本与初级预防成本。检索文献以确定结石病的发病率、非医学预防策略的有效性以及结石管理的相关费用。进行单因素和双因素敏感性分析，以确定初级预防策略具有成本效益的条件。
假设结石发病率为 1%，预防策略可降低 50%的发病风险，每位个体每年的初级预防费用为 100 美元，则模型计算出无初级预防策略和有初级预防策略时，每位个体每年的总成本分别为 46 美元和 123 美元。单因素敏感性分析表明，如果结石发病率每年超过 4.3%，或者预防成本低于每人每年 23 美元，则初级预防策略具有成本效益。改变其他因素（结石发病率、手术概率、旷工时间、急诊室费用）在任何情况下都无法达到成本等效，或者需要不切实际的假设。除非结石病的发病率至少为 1%，预防成本不超过每人每年 20 美元，并且预防策略至少能有效预防 50%的结石，否则预防策略的成本将高于不进行预防。
结石病的初级预防策略尚未得到充分评估，但如果人群中结石病的发病率足够高，且策略成本低、效果中等，理论上可以具有成本效益。
