Expulsive Therapy for Stones May Cut Costs

VANCOUVER—Urologists may want to give patients with acute renal colic a trial of medical expulsive therapy (MET) before recommending early endoscopic stone removal (EESR), a new study suggests.

Patients missed fewer days of work and were less likely to file short-term disability claims after undergoing MET than after having early endoscopic stone removal, researchers reported in a poster presentation at the the 33rd Congress of the Societé Internationale d'Urologie.

John M. Hollingsworth, MD, MS, of the University of Michigan in Ann Arbor, and co-investigators analyzed administrative data from MarketScan to find records of patients aged 18-64 years with renal colic.

The study, which was funded in part by U.S. Agency for Healthcare Research & Quality, excluded individuals with febrile urinary tract infections or renal failure combined with ureteral stones because they are not candidates for MET. The study also excluded patients who had been prescribed an alpha or calcium channel blocker within the 30 days before an index emergency room visit for acute renal colic. The researchers' goal was to isolate the treatment effect of MET.

The investigators focused on 257 patients who received MET. All filled a prescription for nifedipine, tamsulosin, doxazosin, terazosin, alfuzosin, or prazosin within three days of their index emergency department (ED) visit. The investigators compared these patients with a propensity-score matched group of 257 patients who underwent EESR.

The MET and EESR groups had a mean age of 47.0 and 46.6 years, respectively, and similar proportions of patients who lived in urban areas (89.1% and 88.3%) and who were employed full time (89.8% and 93.4%). The two groups also were similar with respect to geographic regions in which they resided (Northeast, Midwest, South, and West).

Results showed that 16.5% of the EESR group filed short-term disability claims compared with 6.0% of the MET group, which translated into a 67% decreased odds of filing a short-term disability claim with MET versus EESR. Among those who filed a short-term disability claim, the mean number of days missed from work was 1.8 in the surgery group compared with 0.9 in the MET group.

“An initial trial of MET is associated with significantly lower indirect costs to the patient when compared to early endoscopic stone removal,” the investigators concluded in their poster.

In an interview with Renal & Urology News, co-investigator Brent K. Hollenbeck, MD, of the University of Michigan in Ann Arbor, noted, “Future studies are needed to evaluate for potential differences in indirect costs across broader populations such as the elderly and the uninsured.”

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