Cost utility analysis of shockwave lithotripsy versus ureteroscopic stone treatment in adults

Objectives: To assess the cost effectiveness, resource use implications, quality adjusted life years (QALY) and the cost per QALY of care pathways starting with either extracorporeal shockwave lithotripsy (SWL) or with ureteroscopic (URS) retrieval for the management of ureteric stones. Patients and methods Data on quality of life and resource use for 613 patients collected prospectively in the TISU randomised controlled trial (RCT) (ISRCTN 92289221) were used to assess the cost effectiveness of two care pathways for SWL and URS. Health provider (National Health Service, UK) perspective was adopted to estimate the costs of the interventions and subsequent resource use. Quality of life data were calculated using a generic instrument, EuroQol EQ-5D-3L. Results are expressed as incremental cost effectiveness ratios and cost effectiveness acceptability curves.
Results: The mean QALY difference (SWL vs. URS) was –0.021 (950.033 to –0.010) and the mean cost difference was –£809 (95£1061 to –£551). The QALY difference translated into approximately 10 more healthy days over the six-month period for the patients in the URS care pathway. The probability that shockwave lithotripsy is cost-effective is 79s willingness to pay for a quality-adjusted life-year of £30,000 and 9820,000 society's willingness to pay for a QALY threshold.
Conclusion: The SWL pathway results in lower QALYs than URS but costs less. The incremental cost per QALY is £39,118 cost saving per QALY loss with a 79effective at £30,000 society’s willingness to pay for a QALY threshold and 9820,000 society’s willingness to pay for a QALY threshold. Decision-makers need to determine if costs saved justify the loss in QALYs.