體外電震波碎石術治療輸尿管下段結石的成本和治療效果的分析

Background and Purpose: In this study, we attempted to estimate the direct medical costs, based on resources utilization and objective outcomes, of extracorporeal shock wave lithotripsy (ESWL) for distal ureteral stones. Methods: From January 2002 through December 2004, 284 distal ureteral calculi were treated using ESWL (Siemens Lithostar Ⅱ). All ESWL treatments were performed with the patient under intravenous sedation and on an outpatient basis. Results: The stone-free rates were 62.2%for stone sizes of ≥1cm, and 81.9%for stone sizes of ＜1cm. Retreatment was required in 9 (19.6%) and 12 cases (7.0%), respectively. Minor complications occurred in 3 patients (1.06%). The direct medical costs of treatment were estimated by resource utilization from the viewpoint of the health provider and derived by adjusting for department-specific cost-to-charge ratios. The mean single treatment costs of ESWL were NT$22,884 and 22,494 (in 2004, the average exchange rate was US$1.00=NT$31.9) for smaller and larger stones, respectively. From the standpoint of benefits and the assumption that 1 point of reimbursement means NT$1, the mean hospital benefit of a single treatment of ESWL of a lower ureteral stone was NT$6138 and 6528 for smaller and larger stones, respectively. Conclusions: The success rates (and direct medical costs) of ESWL for treatment of lower ureteral stones were 81.9% (NT$22,884) and 62.2% (NT$22,494) for smaller and larger stones, respectively.