两种治疗小于 2cm 肾结石/输尿管结石的微创技术直接和间接成本的比较分析。

Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm.

机构信息

Hospital Universitari i Politècnic La Fe, Unidad de Litotricia y endourología, Valencia, Valenciana, España.

出版信息

Actas Urol Esp (Engl Ed). 2020 Sep;44(7):505-511. doi: 10.1016/j.acuro.2020.03.008. Epub 2020 Jun 24.

DOI:10.1016/j.acuro.2020.03.008

PMID:32593640

Abstract

OBJECTIVE

To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm.

MATERIAL AND METHODS

Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment» (WPAI) questionnaire was also used to determine the level of perceived productivity loss.

RESULTS

The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL.

CONCLUSIONS

The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

摘要

目的

对两种微创技术（体外冲击波碎石术（ESWL）与输尿管镜钬激光碎石术（URS/RIRS））治疗小于 2cm 的肾结石/输尿管结石的间接和直接成本进行比较分析。

材料和方法

这是一项前瞻性、非随机、比较性研究，共纳入了 84 名于 2016 年 1 月至 12 月期间接受治疗的肾结石小于 2cm 的患者。其中 38 名（45.67%）接受 ESWL 治疗（18 例肾结石，20 例输尿管结石），46 名（54.32%）接受 URS/RIRS 治疗（22 例肾结石，24 例输尿管结石）。在 URS/RIRS 组中，有 19 名（41.3%）患者和 ESWL 组中有 15 名（39.5%）患者在治疗前是积极工作的。分析的变量包括性别、年龄、结石数量和大小、因治疗而缺勤的天数、因劳动力生产率损失导致的间接成本估计以及直接治疗成本（包括随访，总手术次数、辅助护理、就诊和诊断测试）。使用 2015 年工资结构调查（INE）来估计间接成本。此外，还使用了“工作生产力和活动障碍”（WPAI）问卷来确定感知生产力损失的程度。

结果

ESWL 组结石完全消除的平均治疗次数为 2.57 次，URS 组为 1.04 次。URS 组的平均缺勤天数为 7.16 天，ESWL 组为 3.18 天（p=0.034）。因生产力损失导致的总间接成本分别为 ESWL 组 621.55 欧元和 URS 组 276.05 欧元。ESWL 组的直接治疗成本为 1382.9 欧元，URS 组为 2317.71 欧元。接受 URS 治疗的患者的工作障碍程度为 18.88%，而 ESWL 组为 21.33%。URS 组日常活动能力受损程度为 24.44%，而 ESWL 组为 15%。