Utilization and cost in treatments for stone disease: A critical eye is key

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It is perhaps more important than ever that investigators evaluate cost and utilization with a critical eye to ensure that access to minimally invasive stone procedures is preserved.

In this issue of Urology Times, Scales et al discuss their research on the utilization of shock wave lithotripsy (SWL) and ureteroscopy (URS) in the United States (see, "SWL use higher than URS despite retreatment rate"). Their two studies, which are based on a sample of Medicare patients, found that SWL was used more commonly in the treatment of stone disease, despite having a significantly higher second procedure rate than URS. In addition, the researchers noted that non-clinical factors may influence the choice of URS or SWL.

As the investigators sagely acknowledge, the findings from these studies raise many questions worthy of further investigation. Whether the differences in utilization relate to training, availability of equipment, or facility ownership remains to be determined. Indeed, one might propose that physician-led organizations and facilities may place a higher priority on maintaining up-to-date equipment needed to perform minimally invasive procedures.

Dr. Monga is director of the Stevan B. Streem Center for Endourology & Stone Disease at Cleveland Clinic's Glickman Urological & Kidney Institute.

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