Author/Authors :
Zhang, Yucong Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China - Department of Geriatrics - Tongji Hospital - Tongji Medical College - Huaz hong University of Science and Technology - Wuhan 430030 - China , Ouyang, Wei Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Li, Heng Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Liu, Haoran Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Yuan, Peng Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Lu, Hongyan Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Sun, Xifeng Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Ye, Zhangqun Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Xing, Jinchun Department of Urology - The first affiliated hospital of Xiamen University - Xiamen, China , Chen, Zhiqiang Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China , Xu, Hua Department of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan 430030, China - Hubei Institute of Urology - Tongji Hospital - Tongji Medical College - Huazhong University of Science and Technology - Wuhan, China
Abstract :
Purpose: To assess the cost-effectiveness of medical expulsive therapy (MET) versus observation for large distal ureteral stones in China and provide preliminary evidence for the determination of the course of MET by mathematical estimation.
Materials and Methods: With linear success rate assumptions, a decision tree was constructed by TreeAge Pro 2011 software. The stones passage rates after observation or receiving 0.4 mg daily tamsulosin were estimated according to a large randomized clinical trial (RCT). The costs of ureteroscopy, drugs and examinations were estimated
according to related price from pharmacies or hospitals, or the guidance price published by the government.
MET was also compared with observation by the sensitivity analysis. The effectiveness of MET or observation
was presented by quality-adjusted life-day. Mathematical estimation of stone expulsion time was made by using a
decision-analytic Markov model under the assumption that the daily stone expulsion probability is constant.
Results: In China, the MET was associated with a $295.1 cost advantage over observation. The cost of ureteroscopy
has to decrease to $77.8 to reach cost equivalence between observation and MET. Observation is cost-effective
only if ureteroscopy is very cheap or the difference of stone expulsion rates is insignificant. The estimated expulsion
time was much longer than those reported in above mentioned RCT.
Conclusion: Due to the high cost of ureteroscopy, MET showed a cost advantage over observation in treating distal ureteral stones in China. The daily stone passage rate was inconstant. More studies are needed to find the appropriate duration of MET.
Keywords :
cost-effectiveness , medical expulsive therapy , observation , distal ureteral stones , tamsulosin
