Economic impact of potassium citrate in urolithiasis: A narrative review and economic evidence synthesis.

Abstract

Objectives: Recurrent urolithiasis causes substantial healthcare and economic burden due to high recurrence rates and need for repeated interventions. Potassium citrate effectively prevents stone recurrence, yet its cost-effectiveness compared with nontreatment remains unclear. We aimed to evaluate the economic impact of potassium citrate therapy in the prevention and management of urolithiasis.

Materials and methods: A structured narrative review was conducted to evaluate the economic impact of potassium citrate therapy in urolithiasis. Databases were searched for studies assessing costs, cost-effectiveness, or healthcare resource utilization related to potassium citrate. Due to substantial heterogeneity in analytic perspective, outcomes, time horizons, and healthcare system context, findings were synthesized narratively rather than quantitatively.

Results: The economic evidence base was limited but consistent in demonstrating a meaningful reduction in stone recurrence with potassium citrate therapy. Two decision-analytic economic evaluations showed that potassium citrate substantially lowers recurrence rates compared with conservative management, translating into reduced downstream healthcare utilization. Economic outcomes were most favorable in patients with high baseline recurrence risk and in healthcare systems with lower medication acquisition costs. Across models, recurrence risk, drug pricing, and treatment adherence emerged as clear and reproducible drivers of economic value. No studies incorporated quality-adjusted life years or health utility outcomes.

Conclusion: Potassium citrate is a clinically effective and economically reasonable preventive therapy for recurrent urolithiasis, particularly in high-risk and hypocitraturic patients. When targeted to appropriate populations, it reduces recurrence and can offset downstream treatment costs. The current evidence supports potassium citrate as a key component of preventive stone management.