Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management.
World J Urol
; 42(1): 144, 2024 Mar 13.
Article
em En
| MEDLINE
| ID: mdl-38478078
ABSTRACT
OBJECTIVE:
To prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction. PATIENTS ANDMETHODS:
100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling.RESULTS:
Single procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (8847) for DUL in contrast to £4915 (5580) for EUL.CONCLUSIONS:
Implementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Litotripsia
/
Cálculos Ureterais
Limite:
Humans
/
Middle aged
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article