Clinical Question: What are the mo...

Clinical Question: What are the mostly cost-effective treatment strategies for the medical management of patients with kidney stones?

Setting: Population-based

contemplation Design: Cost-effectiveness analysis

Synopsis: Investigators from Texas makeed a decision tree to estimate the splendor of treatment and follow-up in patients with calcium oxalate renal stones. Using MEDLINE, they identified studies addressing the natural history, evaluation, and medical and surgical treatment of nephrolithiasis. sumptuousnesss of various outcomes were estimated using local hospital and pharmacy charges from couple national chains for specified diagnostic ordeals medications, and surgical procedures.

Six treatment strategies were evaluated: (1) conservative therapy--dietary modification without unsalable article treatment or metabolic evaluation; (2) empiric medical therapy--dietary modification and medicine treatment (potassium citrate) for all patients; (3) modified simple metabolic evaluation--a single 24-hour urine collection for analysis of universal urinary stone risk factors, with potassium citrate and hydrochlorothiazide prescribed for patients with hypercalciuria, and potassium citrate alone for patients with normocalciuria; (4) simple metabolic evaluation--the same evaluation as no. 3 make objection that patients with normocalciuria and no other identifiable abnormality received no remedy therapy; (5) modified comprehensive metabolic evaluation--at least brace 24- hour urine collections for stone risk analysis and a fasting oral calcium load example with similar treatment as in no. 3; and (6) comprehensive metabolic evaluation-- the same work-up as in no. 5 if it were not that with treatment only for patients with an identified disorder. A sensitivity analysis evaluated medication outlay thresholds at varying levels of risk that would achieve charge equivalence with conservative (i.e., diet only) therapy for each treatment strategy.

In patients with first-time kidney stones, conservative therapy was the in the greatest degree cost-effective strategy. In patients with recur-rent kidney stones, empiric therapy and the modified simple metabolic evaluation were equally the greatest in quantity cost-effective strategies. Bottom Line: In patients with first-time kidney stones, conservative therapy (i.e., dietary modification only) is the mostly cost-effective strategy. In patients with renewed kidney stones, empiric therapy (i.e., dietary modification and potassium citrate) and a modified simple metabolic evaluation (i.e., a single 24-hour urine collection for renal stone risk factors, with potassium citrate and hydrochlorothiazide for patients with hypercalciuria and potassium citrate alone for patients with normocalciuria) are equally cost-effective. (Level of Evidence: 2b)

research Reference: Lotan Y, et al. Cost-effectiveness of medical management strategies for nephrolithiasis. J Urol December 2004;172(6 pt 1):2275-81

Used with permission from Slawson D costliness effective medical management of nephrolithiasis. Accessed online December 24 2004 at: http://www.InfoPOEMs.com.

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