Introduction & Objectives
To evaluate the additional costs and the impact on total procedure costs of remaining in the surgical waiting list for the treatment of ureteral stones in a public health system.
Material & Methods
A total of 135 patients, who were diagnosed and treated for ureteral stones, were included in a prospective study from january 2015 to march 2016. All of them met the criteria for endoscopic treatment and were treated by URS with semirigid or flexible ureterorenoscopes and intracorporeal Holmium:YAG laser lithotripsy (URS) under general or spinal anesthesia. The cost analysis included the direct costs for emergency and GP visits, hospital admissions and urgent placement of ureteral stent or percutaneous nephrostomy, before surgical treatment. The waiting time for surgery was recorded as well. For the data analysis we used a linear regression.
Out of a total of 135 patients waiting for URS, 28 (20,7%) had emergency visits, 47 (34,8%) GP visits, 11 (8,1%) hospital admissions and 19 (14,1%) an urgent procedure. Our statistical model selected waiting time (p=0,01), number of emergency visits (p=0,04) and hospital admissions (p= 0,01) before surgery as predictor variables of increasing additional costs (R2 = 0,89). Moreover, women and patients with ureteral stent cause higher additional cost, with statistically significant difference. The size or number of lithiasis did not have statistical significant association. An optimal waiting time cut-off point was established, using a variance analysis. Patients that were waiting for surgery for a period of time shorter than 100 days had additional costs less (231,62 euros) than those with a longer waiting time (593,09 euros) with statistical significance (p <0,05).
The results of this study indicate that the surgical waiting time in ureteral endoscopic treatment for urinary stones had a significant impact on costs, and the procedure should be performed before 100 days after diagnosis.