Primary ureteroscopy versus ureteric stenting in the emergency setting: A costeffectiveness analysis

ABSTRACT

Introduction: Nephrolithiasis represents a significant economic burden worldwide, yet there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a cost-effectiveness analysis between primary treatment and ureteric stenting in patients with ureteric stones in the emergency setting. Patients and Methods: We conducted a retrospective analysis of patients requiring emergency intervention for a ureteric calculus at our institution between January and December 2019. Secondary care cost (SCC) was calculated to include cost of the intervention, inpatient bed days, emergency department (A&E) attendances, additional procedures such as nephrostomy and secondary definitive procedure. Results: A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), to include primary URS (34%) and shock wave lithotripsy (3.6%). Those undergoing primary treatment had significantly less A&E reattendances (10.9% vs 25.7%, p=0.02). SCC was greater in the stenting group (£4485.42 vs £3536.83;p = 0.65). The cost-per-patient related to A&E reattendances was significantly higher in the stenting group (£61.05 vs £20.87;p < 0.001). Conclusions: Performing primary treatment in patients presenting with acute ureteric colic may infer a cost benefit, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.