Background: Kidney stones are the most common case in the field of urology, particularly in Indonesia. Extracorporeal shock wave lithotripsy (ESWL) is one of the therapeutic modalities with the aid of fluoroscopy and/or ultrasonography to visualize the location of the stone. To date, there is no research in Indonesia on the efficacy, safety and cost compatibility between ESWL and their implementation in various hospitals. This study aimed to compare the efficacy, safety and cost of fluoroscopy-ultrasonography-guided ESWL (FU-ESWL) and ultrasonography-guided ESWL (U-ESWL) as target devices in type-C hospitals in Denpasar.
Methods: This research is a quantitative study with a prospective cohort approach that involved two group pre-post-test designs. The intervention was performed using the target device of FU-ESWL at Surya Husadha Hospital and U-ESWL at Balimed Hospital. The population of this study was patients with kidney stones less than 1.5 cm who underwent ESWL. The post-treatment assessment was the efficacy (stone size, stone-free rate (SFR), frequency, re-treatment, auxiliary procedure), safety (complication) and cost (unit cost, perceived cost, actual cost, Average Cost Effectiveness Ratio (ACER), Efficiency Quotient (EQ)).
Results: After treatment, the FU-ESWL group showed a smaller remaining stone size than the U-ESWL group. The ESWL frequency and re-treatment in FU-ESWL showed significantly better results than in U-ESWL. No significant differences in complication and SFR between the two groups. The unit cost of FU-ESWL was significantly higher than U-ESWL. However, the perceived cost and actual cost were not significantly different between the two groups. Moreover, the cost aspect of the average cost-effectiveness ratio (ACER) and efficiency Quotient (EQ) of FU-ESWL is better than U-ESWL.
Conclusion: The combination targeting of FU-ESWL has better efficacy, ACER and EQ than U-ESWL. However, no significant differences were found in complication and SFR between the two groups. Important findings in this research are expected to contribute to monitoring and evaluating the national health insurance implementation in the field of Urology.