A Decision Analysis of Observation vs. Immediate Re-Intervention for Asymptomatic Residual Fragments < 4mm Following Ureteroscopic Lithotripsy

AbstractPurpose:To perform a decision analysis model of the cost-effectiveness of observation vs. intervention for asymptomatic residual fragments less than 4mm in diameter following ureteroscopic holmium laser lithotripsy.Methods:Outcomes data from a retrospective analysis evaluating the natural history, complications, and re-intervention rates of asymptomatic residual stone fragments performed by the EDGE consortium were utilized. A decision analysis model was constructed to compare the cost-effectiveness of initial observation of residual fragments to immediate intervention. Cost of observation accounted for emergency room visits, hospitalizations, and re-interventions. The cost-analysis model extended for 3 years to account for delayed re-intervention rates on fragments less than 4mm. Costs of emergency department visits, readmissions, and re-interventions were calculated based on published figures from the literature.Results:Decision analysis modeling demonstrated that when comparing initial observat...