Cost-efficacy comparison of extracorporeal shock wave lithotripsy and endoscopic laser lithotripsy in distal ureteral stones

Distal ureteral stones are usually treated today by extracorporeal shock wave lithotripsy or extraction by retrograde ureteroscopy with or without previous fragmentation. We performed a cost-efficacy study of three methods to treat them: extracorporeal lithotripsy using either a spark gap lithotripter, the unmodified Dornier HM3 (SWL), or the piezoelectric Wolf Piezolith 2300 (EPL) and endoscopic lasertripsy (LISL) using an alexandrite pulsed laser, the HMT Alexantriptor. The records of 520 patients with distal ureteral stones treated by extracorporeal lithotripsy were reviewed to establish the mean cost of the procedure. Concerning LISL, the first 30 stone patients treated in our institution were evaluated. Four measures were examined: (1) number of sessions; (2) success rate; (3) auxiliary maneuvers; and (4) complications. The economics evaluation considered the direct costs related to personnel, consumables, depreciation, and maintenance. The EPL procedure was the cheapest: $873 US, and SWL the most expensive: $3,572 US. The best cost-efficacy rate was seen with LISL because of its 93% success rate and its cost of $1,390 US.