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Chinese Journal of Endourology(Electronic Edition) ›› 2025, Vol. 19 ›› Issue (03): 346-352. doi: 10.3877/cma.j.issn.1674-3253.2025.03.011

• Clinical Research • Previous Articles     Next Articles

Cost-effectiveness of two lithotripsy methods based on decision tree model

Dongliang Shi1, Yingpeng Wang2, Bin Wan1,2, Haixia Ding1,2,()   

  1. 1. School of pharmacy, Nanjing Medical University, Nanjing 211166,China
    2. Department of Medical Insurance, Jiangsu Province Hospital, Nanjing 210029, China
  • Received:2024-01-02 Online:2025-06-01 Published:2025-05-22
  • Contact: Haixia Ding

Abstract:

Objective

To compare the cost-effectiveness of flexible ureteroscopic lithotripsy(FURL) versus mini-percutaneous nephroscopic lithotripsy (mPCNL) for treating unilateral renal and upper ureteral stones with diameter <2.0 cm.

Methods

The data of 115 patients with unilateral kidney diameter <2.0 cm and upper ureteral calculi admitted in Jiangsu Province Hospital from March to November 2022 were collected, and the decision tree analysis model analyzing outcomes one month after surgery was constructed using Treeage Pro software to evaluate the clinical efficacy,safety and economy of the two lithotripsy procedures.The robustness of the results of this study was verified by one-way sensitivity analysis and probabilistic sensitivity analysis.

Results

The success rate of first lithotripsy in FURL group was significantly higher than that in mPCNL group,with a significant difference (P<0.05), and no significant difference in the occurrence of postoperative complications in the two groups (P>0.05).The basic analysis showed that the FURL cost and health utility were 29 080.9 and 0.90 quality adjusted life years (QALYs), respectively, the cost and health utility of mPCNL group were 26 787.6 and 0.87 QALYs, respectively, the incremental costeffectiveness ratio (ICER) of mPCNL was 76 443.3/QALYs, which was lower than willingness to pay(WTP), so FURL group was the dominant scheme.When the patient's willingness to pay is higher than 60 000 yuan, the FURL group has a higher probability of economy than the mPCNL group, and the sensitivity analysis results verify the robustness of the basic analysis results.

Conclusion

FURL treatment of renal and upper ureteral stones can effectively shorten the operation time and increase the stone clearance rate, which has no significant difference from mPCNL in terms of complications, and has significant cost-effect advantages, with good clinical value and health economic advantages.

Key words: Flexible ureteroscopy, Mini-percutaneous nephrolithotripsy (PCNL), Kidney stone, Decision tree model, Cost-effectiveness analysis

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