Abstract
Objective:
Ureteroscopy (URS) is a primary treatment for ureteral calculi, but its cost-effectiveness depends on whether it is performed as a primary procedure or after pre-stenting. While pre-stenting may improve access and reduce intraoperative complications, it adds procedural costs. This study evaluates the total reimbursed expenditures associated with URS in pre-stented versus non-stented patients within the Israeli healthcare system to determine the most cost-effective strategy.
Methods:
A retrospective analysis was conducted on 228 patients who underwent URS for ureteral stones between 2020 and 2021. Clinical parameters, stone characteristics, and healthcare utilization were recorded. Reimbursement costs were calculated based on emergency department visits, hospitalization, ureteric stent placement, operative time, and additional procedures. Cost-effectiveness was assessed by comparing total expenditures with clinical outcomes.
Results:
Pre-stented patients had larger stones (8.3 ± 4.1 vs 6.7 ± 3.2 mm, p < 0.001) and longer operative times (28.0 ± 22.7 vs 21.5 ± 11.7 min, p = 0.006). Stone-free rates at 3 months were similar (89.3% vs 87.7%, p = 0.70). Primary URS resulted in significantly lower costs for distal ureter stones, while costs at other locations were not significantly different ($5932 vs $6369, p = 0.006).
Conclusion:
Primary URS and pre-stented URS yield comparable clinical outcomes. However, primary URS is more cost-effective for distal ureter stones, emphasizing the importance of economic considerations in treatment selection. These findings reflect reimbursed expenditures and not a formal cost-utility analysis.
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