Many questions being lift up recently regarding what are the most cost-effective treatment strategies for the medical management of patients with kidney stones? This question mark brings some investigation to find out how effective, consider to many factor, did medical institution in this country to provide their patient need for proper medication.
Investigators from Texas constructed a decision tree to estimate the cost of treatment and follow-up in patients with calcium oxalate kidney stones. They try to identify studies addressing the natural history, evaluation, and medical and surgical treatment of nephrolithiasis. The costs of various outcomes were estimated and being compared with local hospital and pharmacy charges from two national chains for specified diagnostic tests, medications, and surgical procedures.
There are six treatment strategies were investigated and evaluated:
1. Conservative therapy
This treatment includes dietary modification without drug treatment or metabolic evaluation.
2. Empiric medical therapy
Using dietary modification and drug treatment, in this case is potassium citrate, and it covered for all patients.
3. Modified simple metabolic evaluation
Collect a sample of 24-hour urine for analysis of common urinary or kidney stones risk factors, with potassium citrate and hydrochlorothiazide prescribed for patients with hypercalciuria, and only potassium citrate for patients with normocalciuria.
4. Simple metabolic evaluation
This evaluation method currently same as modified simple metabolic evaluation except that patients with normocalciuria and identified have no other abnormality received no drug therapy.
5. Modified comprehensive metabolic evaluation
At least two 24- hour urine collections for kidney stones risk analysis and a fasting oral calcium load test with similar treatment as in modified simple metabolic evaluation.
6. Comprehensive metabolic evaluation
Same work-up as in modified comprehensive metabolic evaluation, with only exception for patients with an identified disorder. A sensitivity analysis evaluated medication cost thresholds at varying levels of risk that would achieve cost equivalence with conservative therapy for each treatment strategy.
For first time experience kidney stones patients, conservative therapy was the most cost-effective strategy. In patients with recur-rent kidney stones, empiric therapy and the modified simple metabolic evaluation was equally share the same stage as the most cost-effective strategies. The conclusion is in patients with first-time kidney stones; conservative therapy (i.e., dietary modification only) is the most cost-effective strategy. In patients with recurrent 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.
Compile and re-written based on article by David Slawson
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