Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-3232, USA.
Urology. 2011 Aug;78(2):309-13. doi: 10.1016/j.urology.2011.03.055. Epub 2011 Jun 23.
To examine the effect of preoperative stent placement on total cost of ureteroscopic stone intervention. Passive ureteral dilation with a preoperative ureteral stent has been proposed as a method to facilitate both upper tract access and stone removal.
We retrospectively reviewed the records of patients who underwent ureteroscopic stone intervention at our institution from 2005 to 2009. A sample of patients who had undergone stenting before ureteroscopy was selected and nonstented matched controls were used as a comparison group. A cost model was used to compare the total healthcare costs for the prestented and nonstented patients with a large (>1 cm) and small (≤1 cm) stone burden using the actual cost accrued for each patient. Sensitivity analyses were used to examine the robustness of the cost model.
A total of 104 patients were included in the present study (45 prestented, 59 not prestented). The median stone size was 1 cm (range 0.3-4). The overall stone clearance rate was 95.8%. The median number of procedures was 1. Pre-stenting significantly decreased the total healthcare cost in patients with stones >1 cm. The median cost for the prestented and nonstented cohorts was $17,706 and $27,806, respectively (P < .01). However, prestenting increased the total cost for smaller stones of ≤1 cm, although not significantly. The median cost for the prestented and nonstented cohorts was $10,872 and $12,344, respectively (P = .70). Sensitivity analysis confirmed that the model conclusions are robust.
Preoperative stent placement is cost-effective for successful ureteroscopic treatment of stones >1 cm.
探讨术前支架置入对输尿管镜碎石术总费用的影响。术前输尿管支架的被动扩张被认为是一种便于上尿路进入和碎石的方法。
我们回顾性分析了 2005 年至 2009 年在我院行输尿管镜碎石术的患者记录。选择了一组接受输尿管镜检查前支架置入的患者作为样本，并将未接受支架置入的匹配对照组作为比较组。使用成本模型比较了大（>1cm）和小（≤1cm）结石负担的支架置入组和未支架置入组患者的总医疗保健费用，使用每位患者实际发生的成本进行比较。进行敏感性分析以检查成本模型的稳健性。
本研究共纳入 104 例患者（45 例支架置入，59 例未支架置入）。中位结石大小为 1cm（范围 0.3-4cm）。总体结石清除率为 95.8%。中位数手术次数为 1 次。对于结石>1cm 的患者，支架置入术显著降低了总医疗保健成本。支架置入组和未支架置入组的中位费用分别为 17706 美元和 27806 美元（P<0.01）。然而，支架置入术增加了≤1cm 小结石的总费用，但无统计学意义。支架置入组和未支架置入组的中位费用分别为 10872 美元和 12344 美元（P=0.70）。敏感性分析证实模型结论稳健。
术前支架置入术对于成功治疗>1cm 的输尿管镜碎石术是具有成本效益的。
