SURE procedure linked to reduced healthcare utilization and costs vs ureteroscopy

New analyses from the randomized ASPIRE trial suggest that reducing residual stone volume (RSV) during endoscopic kidney stone surgery may translate into measurable downstream clinical and economic benefits. Data presented at the 41st Annual Congress of the European Association of Urology indicate that the Steerable Ureteroscopic Renal Evacuation (SURE) procedure performed with the CVAC aspiration system was associated with lower health care consumption events (HCEs) and reduced follow-up costs compared with standard ureteroscopy (URS),¹ with RSV emerging as a key predictor of long-term utilization.²

In a model-based economic analysis derived from ASPIRE trial data, SURE was associated with a 64% relative reduction in kidney stone–related HCEs and an estimated $3,464 reduction in 2-year follow-up costs per patient compared with URS. These findings build on a complementary analysis showing that RSV, rather than traditional “stone-free” status, independently predicts downstream health care utilization, reinforcing the clinical relevance of achieving more complete stone clearance.

“For the first time, we have clear evidence of how the clinical value of the CVAC System translates directly into economic value,” said presenting author Brett Johnson, MD, in a news release on the results.³ Evidence across multiple studies has demonstrated that the CVAC System results in a significant reduction in RSV, which in turn is proven to improve long-term patient outcomes. These new health economic data show that consistently achieving low RSV can reduce downstream health care utilization and lower the cost of follow-up care, benefitting the health care ecosystem as a whole.”

The ASPIRE (ASPiration to Improve Renal Calculi Removal Effectiveness) trial was a multicenter, randomized study conducted across 11 US centers evaluating outcomes in 123 adults with renal calculi measuring 7 to 20 mm. Patients underwent either standard URS or SURE using the CVAC aspiration system, with postoperative imaging used to quantify RSV and longitudinal follow-up extending to 2 years.

In the economic analysis, investigators combined patient-level ASPIRE outcomes with published claims datasets, including IBM MarketScan data, to estimate health care utilization and associated costs over a 2-year horizon. Event rates for emergency department visits, retreatments, and hospitalizations were derived from trial data and mapped to 2025 Medicare fee schedules.

The analysis demonstrated that SURE was associated with fewer downstream events, with relative risks of 0.16 for emergency department visits, 0.85 for retreatments, and 0.30 for hospitalizations (combined, 0.299 avoided events). Overall, this translated to a 64% reduction in event-related costs (relative risk, 0.36), with estimated per-patient follow-up costs of $1,958 compared with $5,422 for URS (2-year difference, $3464).

According to the authors, these results “[provide] a basis to partially or fully amortize incremental index treatment cost.”

A related secondary analysis focused on the predictive value of RSV. Among 101 evaluable patients, higher RSV was associated with increased odds of HCEs (odds ratio [OR], 1.67 per 100 mm³; 95% CI, 1.09 to 2.55; P = .018). After adjustment for age and prior urologic surgery, RSV remained independently predictive (adjusted OR, 2.08; 95% CI, 1.29 to 3.34; P = .003), with good model discrimination (area under the curve, 0.776).

In contrast, categorical “stone-free” definitions were not significantly associated with outcomes (P = .07 to .29). According to the authors, the stone-free definitions had “wide confidence intervals, indicating limited precision and predictive value in their true population effect.”

They concluded that conventional stone-free classifications may not accurately reflect true patient risk, and minimizing RSV may help reduce long-term health care utilization.

“The new data build on the robust body of evidence supporting the CVAC System and demonstrate performance across clinical, procedural, and, for the first time, economic outcomes,” said Jacqueline Welch, MD, PhD, VP Medical and Clinical Affairs at Calyxo, in the news release.³ “The breadth and momentum of this evidence underscore our commitment to demonstrating how the CVAC System can improve kidney stone care, supporting more complete and lasting stone clearance while reducing the downstream burden on patients and the health care system.”

REFERENCES

1. Matlaga B, Chi T, Stern K, et al. Health-Economic Implications of the SURE procedure in Kidney Stone Removal: A Claims Data Analysis based on Two-Year Results of the ASPIRE Study. Presented at: 41st Annual Congress of the European Association of Urology. London, UK. March 13-16, 2026. Abstract LB016

2. Johnson B, Stern K, Chi T, et al. Residual stone volume, rather than stone-free status, predicts downstream healthcare utilization after ureteroscopy: Secondary analysis of the ASPIRE trial. Presented at: 41st Annual Congress of the European Association of Urology. London, UK. March 13-16, 2026. Abstract P0417

3. Six New EAU 2026 Abstracts Show CVAC System Delivers Consistently Low Residual Stone Volume, Greater Procedural Efficiency, and Reduced Downstream Clinical and Economic Burden. News release. Calyxo, Inc. March 17, 2026. Accessed March 23, 2026. https://calyxoinc.com/calyxo-news/six-new-eau-2026-abstracts-show-cvac-system-delivers-consistently-low-residual-stone-volume-greater-procedural-efficiency-and-reduced-downstream-clinical-and-economic-burden/