Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or extra-corporeal shock wave lithotripsy
Patel M S, Blacklock N J, Rao P N
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Extra-corporeal shock wave lithotripsy or surgery for the treatment of stones in the kidney and ureter.
Type of intervention
Treatment.
Economic study type
Cost-utility analysis.
Study population
Patients affected by kidney and ureter stones.
Setting
The study was carried out in the United Kingdom.
Dates to which data relate
It seems that price related to 1985.
Modelling
Epidemiological cohort model (model of survival and disease).
Measure of benefits used in the economic analysis
Quality-adjusted life years. A Rosser classification was used for the health state description. The Rosser 1 was used as a basic method of valuation of health states. Author values were used to assess the health states.
Direct costs
Direct costs were to the health service and included: equipment, building, staff, consumables, operation, hotel costs, dialysis, and travel. It seems that price information related to 1985.
Indirect Costs
Production losses were considered.
Currency
UK pounds sterling (). In the DH Register of Cost-Effectiveness Studies, the original results were reflated to 1991, using the NHS pay and prices index.
Sensitivity analysis
Sensitivity analysis was carried out using the method of single parameter variation.
Estimated benefits used in the economic analysis
For treatment of stones in the kidney and ureter by extra-corporeal shock wave lithotripsy incremental QALYs were: 41770 (benefits discounted at 2%), 25340 (benefits discounted at 5%) and 13220 (benefits discounted at 10%). For treatment of stones in the kidney and ureter by conventional surgery, incremental QALYs were: 36040 (benefits discounted at 2%), 21870 (benefits discounted at 5%), and 11410 (benefits discounted at 10%). Outcome duration was 30 years. Treatment side-effects were not included.
Synthesis of costs and benefits
Cost duration was 30 years. Incremental cost per QALY for: Treatment of stones in the kidney and ureter by extra-corporeal shock wave lithotripsy (ESWL) vs. no treatment was 1684 (costs and benefits discounted at 2%); 2469 (costs and benefits discounted at 5%) and 3993 (costs and benefits discounted at 10%). For treatment of stones in the kidney and ureter by conventional surgery vs. no treatment the incremental cost per QALY was: 3095(costs and benefits discounted at 2%); 4522 (costs and benefits discounted at 5%) and; 7216 (costs and benefits discounted at 10%).
CRD Commentary
(This commentary was not written by CRD, but by the authors of the DH Register.) For: Treatment of stones in the kidney and ureter by extra-corporeal shock wave lithotripsy (ESWL). 1) QoL with and without intervention are illustrative only, trial data are needed. 2) It is assumed that 2% of cases will develop renal failure after 5 years without treatment. 3) Long term outcomes, complications and recurrence rates are unknown. 4) Four supra-regional centres using 2nd generation lithotripsy are costed running at full capacity: this is the minimum needed in the UK. For: Treatment of stones in the kidney and ureter by conventional surgery. 5) Survival is modelled by a hazard function and a mortality rate from a mixed age cohort [Buxton and West, 1975]. 6) Open surgery was dominated by Lithotripsy in terms of outcome and cost. 7) There were no health omissions. In general, the parameters investigated by the sensitivity analysis were not adequately justified.
Bibliographic details
Patel M S, Blacklock N J, Rao P N. Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or extra-corporeal shock wave lithotripsy. Health Policy 1987; 8(2): 207-225
Costs and Cost Analysis; Great Britain; Hospital Departments /economics; Humans; Kidney Calculi /therapy; Lithotripsy /economics; Statistics as Topic; Surgery Department, Hospital /economics; Technology Assessment, Biomedical /economics; Urinary Calculi /therapy; Value of Life