Effects of federal policies on extracorporeal shock wave lithotripsy Page: 56
cm. 108 p: ill; 26 cm.View a full description of this report.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
ing percutaneous nephrolithotomy with open sur
gery on patients with equivalent stones (130).
They found that professional charges for per
cutaneous procedures were slightly less than for
open surgery except when percutaneous nephro
lithotomy was performed as a two stage imme
diate procedure (see ch. 3). Professional charges
at this institution and the one also providing
ESWL cannot be compared precisely, because the
patients may not have been equivalent across in
stitutions. It is notable, however, that total profes
sional fees for simple ESWL at the one institution
are lower than professional fees for any percutane
ous or open surgery performed at the institution
without ESWL.
To the extent that relative charges do reflect
relative costs to the hospital, the hospital aver
age charges from Methodist Hospital in Indi
anapolis, summarized in table 10, indicate that
simple ESWL treatment is less expensive to that
hospital than percutaneous or open surgery. How
ever, if additional ESWL treatments or stone
manipulation is needed, the cost savings of ESWL
to the lithotripsy center may be lost.
The above discussion suggests that patients with
stones that can be treated with a single ESWL pro
cedure may have lower total charges (facility plus
professional) than if they underwent either per
cutaneous or open surgery. But some percutane
ous nephrolithotomy patients at the University
of Texas hospital have lower charges than patients
undergoing simple ESWL at the Indianapolis hos
pital, Since the patients and the charges at these
two institutions are not directly comparable, no
firm conclusion can be drawn regarding these two
technologies. Nor is it clear which alternative is
less expensive in total for complicated stones,
since such stones may require more than one
ESWL procedure or a more protracted percutane
ous procedure (or the two in combination). Theone clear conclusion that can be drawn is that
open surgery is usually more expensive than less
invasive technologies, and for simple stones its
use is difficult to justify when alternatives are
available. The relative cost advantages of ESWL
over other technologies, of course, depend on the
extent of use of the facility and, thus, the per case
costs of ESWL treatment.
A factor that should increase the cost advan
tage of ESWL over other technologies is the sig
nificant movement toward ambulatory ESWL, as
evidenced by the three free standing centers treat
ing most of their patients on this basis (86). When
overnight stays are eliminated, the cost of ESWL
and related services may decrease by several hun
dred dollars per patient. These differences may
be more apparent in hospitals offering both in
patient and outpatient ESWL than between hos
pitals and free standing ESWL centers. Charges
for ambulatory treatment at free standing centers
are not necessarily lower than charges for in
patient ESWL, perhaps due to higher construc
tion costs for free standing centers than for
hospital based units. For example, the free stand
ing center in California charges significantly more
for ambulatory ESWL patients than the Method
ist Hospital of Indianapolis does for ESWL in
patients ($7,200 vs. $5,698, physician charges in
cluded).
Percutaneous lithotripsy has now been per
formed on a few ambulatory patients with small
stones (130). To the extent that percutaneous
lithotripsy and ESWL can both be performed on
ambulatory patients or on patients with very short
hospital stays, the facility based part of their costs
may be similar. At present it appears that the ap
plications of ambulatory percutaneous lithotripsy
are much more limited than those of ambulatory
ESWL.DISABILITY COSTS
The short disability time away from normal
activity that is associated with ESWL treatment
is a significant advance over that accompanying
open surgery, and it is probably shorter, on average, than the disability time associated with per
cutaneous lithotripsy. As of mid 1985, ESWL usu
ally required patients to undergo 3 to 4 days of
hospitalization associated with the treatment in
Upcoming Pages
Here’s what’s next.
Search Inside
This report can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Report.
United States. Congress. Office of Technology Assessment. Effects of federal policies on extracorporeal shock wave lithotripsy, report, May 1986; [Washington D.C.]. (https://digital.library.unt.edu/ark:/67531/metadc39606/m1/59/: accessed April 19, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.