Department of Urology, University of Michigan Health System, Ann Arbor, Michigan.
Department of Urology, University of Michigan Health System, Ann Arbor, Michigan.
J Urol. 2014 Mar;191(3):673-7. doi: 10.1016/j.juro.2013.09.028. Epub 2013 Sep 20.
While medical expulsive therapy is associated with lower health care expenditures compared to early endoscopic stone removal in patients with renal colic, little is known about the effect of medical expulsive therapy on indirect costs.
Using a previously validated claims based algorithm we identified a cohort of patients with acute renal colic. After determining the up-front treatment type (ie an initial course of medical expulsive therapy vs early endoscopic stone removal) we compared differences in rates of short-term disability filing. We used propensity score matching to account for differences between treatment groups such that patients treated with medical expulsive therapy vs early endoscopic stone removal were similar with regard to measured characteristics.
In total, 257 (35.8%) and 461 (64.2%) patients were treated with medical expulsive therapy or early endoscopic stone removal, respectively. There were no differences between treatment groups after propensity score matching. In the matched cohort the patients treated with medical expulsive therapy had a 6% predicted probability of filing a claim for short-term disability compared to 16.5% in the early endoscopic stone removal cohort (p <0.0001). Among the patients who filed for short-term disability those prescribed medical expulsive therapy had on average 1 fewer day of disability than those treated surgically (0.9 vs 1.8 days, p <0.001).
An initial trial of medical expulsive therapy is associated with significantly lower indirect costs to the patient compared to early endoscopic stone removal. These findings have implications for providers when counseling patients with acute renal colic.
与早期内镜取石相比，对于肾绞痛患者，药物排石疗法与较低的医疗保健支出相关，但对于药物排石疗法对间接成本的影响知之甚少。
使用先前验证的基于索赔的算法，我们确定了一组急性肾绞痛患者队列。在确定初始治疗类型（即初始药物排石疗法与早期内镜取石）后，我们比较了短期残疾申请率的差异。我们使用倾向评分匹配来解释治疗组之间的差异，以使接受药物排石疗法与早期内镜取石治疗的患者在测量特征方面相似。
共有 257（35.8%）和 461（64.2%）例患者分别接受了药物排石疗法或早期内镜取石治疗。在倾向评分匹配后，两组之间无差异。在匹配队列中，接受药物排石疗法治疗的患者短期残疾申请的预测概率为 6%，而早期内镜取石治疗组为 16.5%（p <0.0001）。在申请短期残疾的患者中，接受药物排石疗法治疗的患者平均残疾天数比接受手术治疗的患者少 1 天（0.9 天比 1.8 天，p <0.001）。
与早期内镜取石相比，初始尝试药物排石疗法与患者的间接成本显著降低相关。这些发现对为急性肾绞痛患者提供咨询的医务人员具有重要意义。
