OBJECTIVE: We determined the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy and compared its cost-effectiveness with percutaneous nephrolithotomy (PCNL) for the management of lower pole renal calculi with a size of 1.0cm to 2.0cm in widest dimension.

MATERIALS AND METHODS: Using the cost estimate data available locally from patient billing charges and average professional fee, efficacy and complication rates data from the literature, the cost-effectiveness for the percutaneous nephrolithotomy and shock wave lithotripsy as primary therapy for lower pole stones were evaluated. We developed a decision analysis model in which a patient in whom primary therapy (either ESWL or PCNL failed was rendered stone-free with secondary ESWL using a trial version add-in software for Microsoft Excel from www.TreePlan.com with some modifications.

RESULTS: The average cost over all outcomes from the decision to perform ESWL in patients with lower pole stones 1.0 to 2.0 cm is Php 53,801.07 and Php 127,019.27 for PCNL. For PCNL to be as cost effective, cost incurred should be lowered to Php 47,746.38

CONCLUSIONS: Extracoporeal shock wave lithotripsy, despite its considerable low efficacy as compared to PCNL as a primary treatment for lower pole stones 1.0 to 2.0 cm, is still more cost-effective.