Medical Devices: Evidence and Research (Nov 2022)
Incremental Healthcare Cost Implications of Retreatment Following Ureteroscopy or Percutaneous Nephrolithotomy for Upper Urinary Tract Stones: A Population-Based Study of Commercially-Insured US Adults
Abstract
Stephen S Johnston,1 Brian Po-Han Chen,2 Pragya Rai,1 Philippe Grange,3 Harikumaran R Dwarakanathan,4 Tony Amos,5 Barbara H Johnson,1 Sudip K Ghosh,2 Noor Buchholz6 1MedTech Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA; 2Health Economics and Market Access, Ethicon, Raritan, NJ, USA; 3Medical Affairs, Johnson & Johnson, Cincinnati, OH, USA; 4MuSigma, Bengaluru, Karnataka, India; 5Real World and Integrated Evidence Strategy, LCI, Johnson & Johnson, New Brunswick, NJ, USA; 6U-Merge Ltd. (Urology for Emerging Countries), London, UKCorrespondence: Stephen S Johnston, Real-World Data Analytics and Research, Epidemiology - MedTech Epidemiology and Real-World Data Sciences, Johnson & Johnson, 410 George Street, New Brunswick, NJ, 08901, USA, Tel +1-443-254-2222, Email [email protected]: This study describes the incremental healthcare costs associated with retreatment among adults undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for upper urinary tract stones (UUTS).Patients and Methods: The IBM® MarketScan® Commercial Database was used to identify adults aged 18– 64 years with UUTS treated with URS or PCNL between January 2010 and December 2019. Patients had 12 months of continuous insurance coverage before (baseline) and after (follow-up) the first (index) procedure. The primary outcome was total all-cause healthcare costs measured over the 365-day follow-up period, not inclusive of index costs. Generalized linear models were used to estimate the incremental costs associated with retreatment within 90 (early) or 91– 365 days post-index (later) relative no retreatment. The models adjusted for demographics, comorbidities, stone(s) location, treatment setting, procedural characteristics (eg, 1-step vs 2-step PCNL) and index year.Results: Approximately 23% (27,402/119,800) of URS patients were retreated (82% had early retreatments). The adjusted mean total cost was $10,478 (95% CI: $10,281—$10,675) for patients with no retreatment, $25,476 (95% CI: $24,947—$26,004) for early retreatment ($14,998 incremental increase, p< 0.01), and $32,868 [95% CI: $31,887—$33,850] for later retreatment ($22,391 incremental increase, p< 0.01). Approximately 36% (1957/5516) of PCNL patients were retreated (78% had early retreatments). The adjusted mean total cost was $13,446 (95% CI: $12,659—$14,273) for patients with no retreatment, $37,036 [95% CI: $34,926—$39,145]) for early retreatment ($23,570 incremental increase, p< 0.01), and $35,359 (95% CI: $32,234—$38,484) for later retreatment ($21,893 incremental increase, p< 0.01).Conclusion: Retreatment during the first year following URS or PCNL was needed in 23% and 36% of patients, respectively, and was associated with an economic burden of up to $23,500 per patient. The high rate of retreatment and associated costs demonstrate there is an unmet need to improve mid- to long-term results in URS and PCNL.Keywords: economic analysis, follow-up, kidney stone, post-procedure, urolithiasis
