Economic evaluation of surgical treatments for urolithiasis in a public hospital.

Abstract

Objectives: To evaluate the costs associated with the surgical treatment of urolithiasis using percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS), and to analyze the influence of direct and indirect costs on patient economy and the healthcare system.

Materials and methods: A total of 179 patients who underwent surgery for urolithiasis between January 1 and December 31, 2023, were included. Direct costs were recorded, encompassing expenses related to the surgical procedure, hospital stay, and healthcare costs, which included consultations, diagnostic procedures and non-hospital medications. Indirect costs were evaluated as non-healthcare costs, specifically focusing on productivity loss due to absenteeism in employed patients. Average costs per patient were calculated in euros (€).

Results: The study found no statistically significant differences in the median total direct costs between patients undergoing PCNL: €15,976 [€13,135-€21,698] and URS: €14,044 [€9,691-€17,696]; p = 0.148). Similarly, the median indirect costs were comparable: €7,800 [€2,323-€7,800] for PCNL and €5,390 [€2,254-€11,136] for URS (p = 0.514). After the interventions, the median time off work was 56 days for PCNL and 30 days for URS, with associated median expenses of €3,558 (± €2,681) and €1,967 [€1,083-€3,168], respectively.

Conclusion: The study found no significant differences in direct or indirect costs between PCNL and URS, suggesting both have a comparable economic impact. While factors like procedure complexity and hospitalization may affect individual costs, they do not create notable disparities. A comprehensive evaluation of both direct and indirect costs remains crucial to optimize resource allocation and support informed clinical decision-making in the healthcare system.