Primary ureteroscopy versus ureteric stenting in the emergency setting: A costeffectiveness analysis

Introduction: Nephrolithiasis represents a significant economic burden worldwide, yet there is a lack of data reviewing the cost-effectiveness of current treatment modalities. We present a cost-effectiveness analysis between primary treatment and ureteric stenting in patients with ureteric stones in the emergency setting. Patients and Methods: We conducted a retrospective analysis of patients requiring emergency intervention for a ureteric calculus at our institution between January and December 2019. Secondary care cost (SCC) was calculated to include cost of the intervention, inpatient bed days, emergency department (AEp = 0.65). The cost-per-patient related to AEp < 0.001). Conclusions: Performing primary treatment in patients presenting with acute ureteric colic may infer a cost benefit, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered, in concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.