Retrograde intrarenal surgery cost-effective option for managing 1-2 cm renal stones

The research is published in the Urology Journal.

Kevin M. Wymer and colleagues from the Department of Urology, Mayo Clinic, Rochester, conducted the recent study to perform a cost-effectiveness evaluation comparing the management options for mid-size (1-2cm) renal stones including percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and shockwave lithotripsy (SWL).

The authors created a Markov model to compare cost-effectiveness of percutaneous nephrolithotomy, mini- percutaneous nephrolithotomy, retrograde intrarenal surgery, and shockwave lithotripsy for 1-2cm lower pole (index patient 1) and percutaneous nephrolithotomy, retrograde intrarenal surgery, and shockwave lithotripsy for 1-2 cm non–lower pole (index patient 2) renal stones.

A literature review provided stone free, complication, retreatment, secondary procedure rates, and quality adjusted life years (QALYs). Medicare costs were used. The incremental cost-effectiveness ratio (ICER) was compared with a willingness-to-pay(WTP) threshold. One-way and probabilistic sensitivity analyses were performed.

The study results showed that at 3 years, costs for index patient 1 were $10,290(PCNL), $10,109(mini-PCNL), $5,930(RIRS), and $10,916(SWL). Mini- percutaneous nephrolithotomy resulted in the highest QALYs(2.953) followed by percutaneous nephrolithotomy (2.951), retrograde intrarenal surgery (2.946), and shockwave lithotripsy(2.943).

This translated to retrograde intrarenal surgery being most cost-effective followed by mini- percutaneous nephrolithotomy (ICER $624,075/QALY) and percutaneous nephrolithotomy (ICER $946,464/QALY). Shockwave lithotripsy was dominated with higher costs and lower effectiveness.

For index patient 2, retrograde intrarenal surgery dominated both percutaneous nephrolithotomy and shockwave lithotripsy. For index patient 1: mini- percutaneous nephrolithotomy and percutaneous nephrolithotomy became cost effective if cost ≤$5,940 and ≤$5,390, respectively.

Shockwave lithotripsy became cost-effective with SFR ≥75% or cost ≤$1,236. On probabilistic sensitivity analysis, the most cost-effective strategy was retrograde intrarenal surgery in 97%, mini- percutaneous nephrolithotomy in 2%, percutaneous nephrolithotomy in 1%, and shockwave lithotripsy in 0% of simulations.

As a result, it was concluded that for 1-2cm renal stones, retrograde intrarenal surgery is most cost-effective. However, mini and standard percutaneous nephrolithotomy could become cost-effective at lower costs, particularly for lower pole stones.

For further reference, log in to:

https://doi.org/10.1016/j.urology.2021.06.030