| Summary: | 碩士 === 臺北醫學大學 === 醫務管理學系 === 94 === The aim of the study is to estimate the direct medical cost, based on resources utilization and objective outcomes of these two treatment modalities for distal ureteral stone. Economic analysis was done from the point of view of health providers.
From Jan. 2002 through Dec. 2004, 1034 distal ureteral calculi were treated using either ESWL (Siemens Lithostar II electromagnetic ESWL in 284 patients) or ureteroscopy (750 patients). Patient age and stone size were similar among the groups. All ESWL treatments were performed with the patient under intravenous sedation and on outpatient basis. Stone free rate were 62.2% for stone size larger than 1 cm, and 81.9% for stone size less than 1 cm. Retreatment was required in 9 cases (19.6%) and 12 cases (7.0%) respectively. The ureteroscopy treatments were performed under spinal or general anesthesia and on inpatient basis. Stone free rate were 86.5% for larger stone and 94.5% for smaller one. Retreatment was also required in 5 cases (5.2%) and 6 cases (1.49%) respectively.
The direct medical cost of treatment was estimated by resources utilization from the viewpoint of health provider and derived by adjusting for department-specific cost-to-charge ratios. The decision analysis model was constructed to estimate the expected treatment costs of each strategy. The successful rates of each treatment modality were determined from outcomes in this series. Overall ESWL was less costly than ureteroscopy in single treatment cost and expected treatment cost for any stone size. A cost difference between the 2 modalities for smaller stone and larger was 7425 NTD and 7417 NTD for single treatment cost, respectively. For smaller stone, the expected cost of ESWL and ureteroscopy were 30315 NTD and 32155 NTD, respectively. For larger stone, the expected cost of ESWL and ureteroscopy were 36672 NTD and 37621 NTD, respectively. The high inpatient cost and professional fee is responsible for the high treatment cost associated with ureteroscopy. From the benefit standpoint, ESWL was a few thousand dollars more than ureteroscopy for hospital.
Conclusions: From the viewpoint of hospital, ESWL is less cost expense and more benefit treatment strategy for distal ureteral stones by resources utilization. However, ureteroscopy is more cost effective in stone clearance.
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