School of Pharmacy, Sungkyunkwan University, Suwon, Korea.
Department of Urology, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
Yonsei Med J. 2020 Jun;61(6):515-523. doi: 10.3349/ymj.2020.61.6.515.
This study aimed to evaluate the cost-effectiveness of treatment with retrograde intrarenal surgery (RIRS) versus repeated shock wave lithotripsy (SWL) in patients with renal calculi.
The non-retreatment rates (NRRs) and their respective real-world costs for RIRS and SWL were derived through retrospective analysis of health insurance claims data from 2015 to 2017. Decision tree modeling was performed to demonstrate the cost-effectiveness of RIRS. Furthermore, sensitivity analysis was performed to examine the robustness of the results.
Analysis of the obtained data showed that NRRs of single SWL ranged from 46% to 56%, whereas NRRs of single RIRS ranged from 75% to 93%. Introducing RIRS early in the treatment sequence was observed to be favorable for the reduction of overall failure (overall NRR, 0.997) compared to the results of repeated SWL (overall NRR, 0.928). The implementation of decision tree modeling revealed that the cost per retreatment-avoided increased with the introduction of RIRS at an earlier time (first line, second line, third line, fourth line: 18640 USD, 10376 USD, 4294 USD, 3377 USD, respectively). Probabilistic modeling also indicated that the introduction of RIRS as the first line of treatment was least likely to be cost-effective, when compared to other options of introducing RIRS as the second, third, or fourth line of treatment.
Performing RIRS as early as possible can be recommended for eligible patients to reduce the overall failure, even if it is not as cost-effective as performing RIRS later.
本研究旨在评估肾结石患者接受逆行肾内手术（RIRS）与多次体外冲击波碎石术（SWL）治疗的成本效益。
通过对 2015 年至 2017 年医疗保险索赔数据的回顾性分析，得出 RIRS 和 SWL 的非重复治疗率（NRR）及其实际成本。采用决策树模型展示 RIRS 的成本效益。此外，还进行了敏感性分析以检验结果的稳健性。
数据分析显示，单次 SWL 的 NRR 范围为 46%至 56%，而单次 RIRS 的 NRR 范围为 75%至 93%。与重复 SWL 相比，早期引入 RIRS 治疗方案可显著降低整体治疗失败率（整体 NRR：0.997 对 0.928）。决策树模型的实施表明，与重复 SWL 相比，RIRS 越早引入，避免一次治疗失败所增加的成本就越高（一线、二线、三线、四线：18640 美元、10376 美元、4294 美元、3377 美元）。概率模型也表明，与将 RIRS 作为二线、三线或四线治疗方案相比，将 RIRS 作为一线治疗方案不太可能具有成本效益。
对于符合条件的患者，尽早进行 RIRS 治疗可以降低整体治疗失败率，即使其成本效益不如晚期 RIRS 治疗方案。
