Presented by: Sundaram Palaniappan
Sengkang General Hospital

Introduction

The utility of Endoscopic Combined Intrarenal Surgery (ECIRS) as a superior alternative to Percutaneous Nephrolithotripsy (PCNL) in terms of safety, efficacy, and lower rates of complications has been established, despite the higher costs involved due to the requirement of dual surgical modalities and surgeons. The primary objective of this study was conducting a cost-effectiveness analysis between these two therapeutic strategies for renal stones which, surprisingly, remains unexplored. We aimed to investigate the cost-utility of adopting ECIRS as the preliminary treatment strategy in comparison to PCNL, considering real-world outcomes and follow-up data to identify the optimal approach for large renal stones.

Materials

A microsimulation model was designed using TreeAge Pro to ascertain the impact of two treatment strategies, namely PCNL and initial ECIRS, on the stone-free rates, costs, secondary procedure requirements, and Quality-Adjusted Life-Years (QALYs). The model employed a 3-year time horizon and a 3-month cycle length. A Markov model alongside a probabilistic sensitivity analysis was incorporated to calculate the costs and outcomes associated with the two strategies. Further, the cost-effectiveness of the treatments was evaluated across various willingness-to-pay (WTP) thresholds.

Results

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At the 3-year horizon, the incremental costs with respect to PCNL were approximately S$3700, and the QALY increment was 0.08. ECIRS as the preliminary treatment, although more expensive, was found to be superior in effectiveness compared to PCNL, exhibiting a decreased complication rate (20% vs 35%) and an enhanced stone-free rate (73.33% vs 58.75%). The approximate incremental cost per QALY gained was S$47,950, establishing ECIRS as a cost-effective option at a WTP threshold of S$50,000. However, a probabilistic sensitivity analysis revealed that merely 46.6% of the simulation fell beneath the WTP threshold of S$50,000.

 

Conclusion

This study underpins the potential of ECIRS to be a cost-effective initial treatment strategy for patients diagnosed with renal stones, who may otherwise undergo PCNL. The cost-efficiency was primarily driven by reduced complication rates and improved stone-free rates.

Funding

None

Lead Authors

Joshua Yi Min Tung,
Sengkang General Hospital

Co-Authors

Xinyan Yang,
Sengkang General Hospital

Alvin Wei Xiang Low,
Sengkang General Hospital

Yongwei Lim,
Sengkang General Hospital