(225) Healthcare Cost of Retreatment Following Ureteroscopy or Percutaneous Nephrolithotomy for Urinary System Stone Disease

Publication Number: 899

Background: Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are minimally-invasive procedures used in the treatment of urinary system stone disease (USSD). Additional procedures after URS or PCNL may be required due to early contra- or ipsilateral stone recurrence, regrowth of residual fragments, or planned staged procedures, all of which impose a burden on the patient and healthcare system.

Objectives: To describe incremental healthcare costs associated with retreatment among adults undergoing URS or PCNL for USSD.

Methods: The IBM® MarketScan® Commercial Database was used to identify adults aged 18-64 years with USSD treated with URS or PCNL between 2010—2019. Patients had 12 months of continuous insurance coverage before (baseline) and after (follow-up) the first (index) procedure. The primary outcome was total (all-cause) healthcare costs measured over the follow-up period, not inclusive of index. Generalized linear models were used to estimate the incremental costs associated with retreatment (URS, PCNL, or extracorporeal shock wave lithotripsy [SWL]) within 90 (early) or 91-365 days post-index (later) vs. those no retreatment. The models adjusted for demographics, comorbidities, stone(s) location, treatment setting, procedural characteristics (e.g., 1-step vs. 2-step PCNL) and index year.

Results: ver the 12-month follow-up period, approximately 23% (27,402/119,800) of URS patients were retreated (82% had early retreatments) and 36% (1,957/5,516) of PCNL patients were retreated (78% had early retreatments). Among patients with retreatment during follow-up, modalities of retreatment were as follows: URS – 2.6% retreated with PCNL, 62.8% with URS, 36.8% with SWL; PCNL – 37.1% retreated with PCNL, 38.8% with URS, 28.5% with SWL. Retreatment was associated with statistically significant incremental healthcare cost increases (all P< 0.001): URS had a $14,998 (95% CI: $14,507–$15,488) increase with early retreatment and a $22,391 (95% CI: $21,445–$23,336) increase with later retreatment; PCNL had a $23,570 (95% CI: $21,411–$25,728) increase with early retreatment and a $21,893 (95% CI: $18,770–$25,015) increase with later retreatment.

Conclusions: Retreatment during the first year following URS or PCNL is common, with associated economic burden of up to $23,500 per patient. The high rate of early retreatment and associated costs demonstrate that there is an unmet need to improve mid- to long-term results in URS and PCNL.