MP65-17 IS PRIMARY URETEROSCOPY MORE COST-EFFECTIVE THAN URETERAL STENTING FOR OBSTRUCTING URETERAL CALCULI?

INTRODUCTION AND OBJECTIVE: The increasing prevalence of nephrolithiasis represents a significant economic burden worldwide making cost-reduction essential. Given that 20% of patients with ureteral colic require acute surgical intervention, there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a costeffectiveness analysis between primary treatment and ureteral stenting in patients with ureteral stones in the emergency setting. METHODS: We performed a retrospective analysis of patients requiring emergency intervention for a ureteral calculus at a single institution between January and December 2019. All patients underwent ureteral stenting, primary ureteroscopy (URS) or shock wave lithotripsy (SWL). The overall secondary care cost was calculated to include the cost of the procedure, inpatient hospital bed days, emergency room (ER) attendances, additional procedures such as nephrostomy insertion and secondary definitive procedure. RESULTS: A total of 244 patients were included. Ureteral stenting was performed in 152 patients (62.3%) and primary treatment in 92 patients (37.7%), of those, 83 patients (34.0%) underwent primary URS and 9 patients (3.6%) had SWL. Those undergoing ureteral stenting had a significantly higher ER reattendance rate (25.7% vs 10.9%, >p=0.02). The overall secondary care cost was greater in the ureteral stenting group (£4485.42 vs £3536.83;>p=0.65). The average cost per patient related to ER reattendances was significantly higher in the ureteral stenting group compared with the primary treatment group (£61.05 vs £20.87;>p < 0.001). CONCLUSIONS: The current study highlights the potential overall cost-reduction when performing primary treatment in patients presenting with acute ureteral colic, predominantly related to reduced ER attendances. This is particularly relevant in the COVID-19 pandemic where it is crucial to avoid unnecessary attendances to the ER and reduce the backlog of delayed definitive procedures. Both primary URS and SWL in the acute setting should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.