Economics of stone disease/treatment

OBJECTIVES: Urolithiasis is a considerable economic burden for health systems, especially in industrialised countries where the incidence of stone disease has increased during the last few decades, and probably will further increase for several reasons. METHODS: The survey was based on investigations in collaboration with a German health insurance company and on a literature search (PubMed, and the author’s collection of proceedings of urolithiasis conferences: The keywords included economics, cost, urolithiasis, nephrolithiasis, renal stone disease, metaphylaxis, recurrence) during 1999–2011. In all, 1221 articles were found but only those cited here were sufficient for the purpose of the study. Due to the nature of the subject it is not possible to give levels of evidence, as economic data on stone treatment cannot be obtained with randomised studies. RESULTS: The costs for the treatment and diagnosis of stones vary tremendously among different healthcare systems. Several calculation models showed that metaphylaxis is medically and economically effective when used rationally. Rational metaphylaxis is restricted to patients with a high risk of recurrence (brushite, uric acid, cystine and infected stones, patients with residual fragments after stone treatment and recurrent calcium oxalate stone formers). CONCLUSIONS: For the groups identified, metaphylaxis is cost-effective in almost all healthcare systems, but the cost saved differs. The savings increase even more when adding the economic loss avoided from days off work due to treatment of recurrent stones. In most countries, stone frequency must exceed one stone per patient per year before medical therapy is more cost-effective than dietary measures.