Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopic Laser Lithotripsy: A Cost Comparison Analysis

The pulsed dye laser has been shown to be effective for the fragmentation of ureteral calculi, and with the widespread introduction of extracorporeal shock wave lithotripsy (ESWL), many ureteral stones also are being treated with this modality. In the last 12 months at the Ohio Kidney Stone Center, approximately 90% of patients with ureteral stones were receiving an invasive adjunctive procedure prior to or after ESWL, making a comparison of costs of treatment with and without ESWL appropriate. A comparison of costs in 20 patients revealed that the pulsed dye laser is more cost effective than ESWL using current techniques. The total cost for a standard 1-day hospitalization and ESWL is approximately $6000, whereas the total cost for laser lithotripsy with a 1-day hospital stay is approximately $3500. The ESWL facility charges (i.e., the technology cost) account for most of the difference. Newer ureteroscopic techniques and instrumentation should increase utilization of the pulsed dye laser for the treatment of ureteral stones.