Contemporary Assessment of the Economic Burden of Upper Urinary Tract Stone Disease in the United States: Analysis of 1-year Healthcare Costs, 2011-2018.

Background The United States healthcare landscape has witnessed numerous changes since implementation of the Affordable Care Act coupled with rising prevalence of upper urinary tract stone disease. Data on the economic burden of stone disease during this period are lacking, providing the objective of our study. Materials and Methods Adults diagnosed with stone disease from 2011-2018 were identified from PearlDiver Mariner, a national all-payer database reporting reimbursements and prescription costs for all healthcare encounters. Patients undergoing operative and non-operative care were identified. Time trends in annual expenditures were evaluated. Multivariable analysis evaluated determinants of spending. Results A total of $10B were spent on stone disease management between 2011-2018 (median overall annual expenditure=$1.4B) among 786,756 patients. Inpatient, prescription and outpatient costs accounted for 34.7%, 20.7% and 44.6% of expenditures respectively. 78% of patients were managed non-operatively (total cost=$6.9B). Average overall cost per encounter was $13,587 ($17,102 for surgical vs. $11,174 for non-surgical care). Expenditures on inpatient care decreased significantly over time, while expenditures on prescriptions and outpatient care increased significantly. On multivariable analysis, higher Charlson Comorbidity Index was associated with higher spending, while associations for age, insurance and region varied by treatment modality. Conclusions The economic burden of stone disease management is substantial, dominated by expenditure on non-operative management and outpatient care. Expenditures for prescription and outpatient care are rising, with the only consistent predictor of higher spending being Charlson Comorbidity Index. Spending variation according to demographic, clinical, and geographic factors was evident.