Presented by: Amit Shemesh MD
Samson Assuta Ashdod University Hospital

Introduction

The growing incidence of urolithiasis is reflected in a significant financial burden, with increasing direct and indirect costs. The aim of this study is to evaluate the direct healthcare expenditure of ureteral stone management in Emergency Department (ED) patients in relation to stone characteristics and imaging features.

Materials

A retrospective analysis was conducted on all patients admitted to the ED and found to have a ureteric stone on CT. Clinical, laboratory, and imaging parameters were collected, along with data regarding admissions, ED readmissions, surgical procedures, and the total cost of treatment. The different cost rates were compared with regard to different stone parameters and characteristics, patient clinical presentation, and laboratory results.

Results

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Between January 2018 and January 2020, an abdominal CT-proven ureteric stone was found in 805 patients during an ED visit in a single institution. Of those, 773 patients met the inclusion criteria. The mean stone size was 4.73 mm, with 31% (238) located proximally and 69% (535) located distally. Treatment costs were inversely related to stone size, costing $3,133, $9,181, and $15,525 for stones smaller than 5 mm, between 5-10 mm, and larger than 10 mm, respectively (p<0.001). Treating proximal stones carried a higher expenditure rate of $9,864 on average, compared to $3,919 for treating distal stones (p<0.001). Stone composition was available for only 240 patients. Struvite stones were the most expensive to treat at $14,251, followed by Calcium phosphate stone (CaPh) at $13,135. Uric acid (UA) stones incurred costs of $10,758, Calcium oxalate monohydrate (COM) $9,697, Calcium oxalate dihydrate (COD) $9,373, and Cystine, with only a single patient with this stone composition, cost $278 (p<0.001). The presence of renal stone, hydronephrosis, and urinoma were associated with higher expenditure rates ($6944 vs $4878, p<0.001; $5871 vs $1581, p=0.007; $8767 vs $5458, p<0.001, for renal stone, hydronephrosis, and urinoma, respectively).

Conclusion

Treatment costs were significantly affected by stone size, location, and composition. Ureteral stones with unfavorable expulsion features and/or surgical complexity, such as infectious state, denser stone, and concomitant renal stones, are associated with increased direct treatment costs in the management of ureteric stones.

 

Funding

None

Co-Authors

Dor Golomb, MD
Samson Assuta Ashdod University Hospital

Hanan Goldberg, MD, MSc
SUNY Upstate Medical University

Eyal Hen, MD
Samson Assuta Ashdod University Hospital

Fahed Atamna, MD
Samson Assuta Ashdod University Hospital

Amir Cooper, MD
Samson Assuta Ashdod University Hospital

Orit Raz, MD
Samson Assuta Ashdod University Hospital