Lehtoranta K
Department of Urology, Helsinki University Central Hospital, Finland.
Scand J Urol Nephrol. 1995 Dec;29(4):437-47. doi: 10.3109/00365599509180025.
The cost and effectiveness of seventy-six consecutive percutaneous nephrolithotomy (PNL) procedures performed during the years 1990-1992, a sample of 425 ESWL patients with 675 treatments from 1991-1992, and 45 successive open pyelolithotomies (PL) performed before the advent of the new stone treatment techniques during the years 1981-1985, were studied for each of the treatment modalities. The costs were counted per patient and based on the cumulative charge of the procedures, cost for in-patient care, and treatment of additional procedures and operatively treated complications. The results showed that the great majority of ESWL patients were treated at a low cost and with few additional procedures and complications compared to PNL, particularly, when stones smaller than 20 mm were treated. Considering all the patients, the cumulative mean hospital cost per patient without the cost for the follow-up was as follows, FIM (pound): PL 33860(4200), PNL 63360(7860), and ESWL 17430(2160). The remarkable number of additional and auxiliary measures (including the pre- and post-operative ESWL procedures) resulted in considerable extra costs for the PNL patients until they were rendered stone-free. Another series comprising 42 successive patients with 48 stone basket procedures (SB) from the years 1981-1985 was retrospectively compared to 42 patients with 50 ureteroscopic stone extractions (URS) between January 1985 and April 1988 before the beginning of the ESWL practice in Finland as well as to 54 patients with 79 ESWL treatments for a lower ureteric stone during the years 1991-1992. The stone-free status after the three procedures until one month was 71, 66, and 60%, with no statistically significant difference. In the group of lower ureteric stones the cumulative mean hospital cost per patient was as follows, FIM (pound): SB 19520(2420), URS 17750(2200), and ESWL 17810(2210). Also in the treatment of lower ureteric stones, ESWL is an equally cost-effective method representing an alternative worth consideration, particularly for patients preferring a minimally invasive urinary stone treatment.
对1990 - 1992年期间连续进行的76例经皮肾镜取石术（PNL）、1991 - 1992年425例接受675次体外冲击波碎石术（ESWL）治疗的患者样本以及1981 - 1985年在新的结石治疗技术出现之前连续进行的45例开放性肾盂切开取石术（PL）的成本和效果进行了研究。对于每种治疗方式，成本按患者计算，基于手术的累计费用、住院护理费用以及额外手术和手术治疗并发症的治疗费用。结果显示，与PNL相比，绝大多数ESWL患者治疗成本低，额外手术和并发症少，特别是在治疗小于20毫米的结石时。考虑所有患者，每位患者在不包括随访费用的情况下的累计平均住院成本如下，芬兰马克（英镑）：PL为33860（4200），PNL为63360（7860），ESWL为17430（2160）。大量的额外和辅助措施（包括术前和术后的ESWL手术）导致PNL患者在结石清除之前产生了相当多的额外费用。回顾性比较了1981 - 1985年连续42例接受48次结石篮取石术（SB）的患者系列与1985年1月至1988年4月在芬兰开始ESWL治疗之前42例接受50次输尿管镜取石术（URS）的患者以及1991 - 1992年期间54例接受79次ESWL治疗下尿路结石的患者。三种手术术后直至1个月的结石清除率分别为71%、66%和60%，无统计学显著差异。在下尿路结石组中，每位患者的累计平均住院成本如下，芬兰马克（英镑）：SB为19520（2420），URS为17750（2200），ESWL为17810（2210）。同样在下尿路结石的治疗中，ESWL是一种同样具有成本效益的方法，是一种值得考虑的替代方法，特别是对于倾向于微创尿路结石治疗的患者。
