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

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.

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