FACTORS INFLUENCING HEALTHCARE COSTS FOR LITHOTRIPSY: ANALYSIS USING PREMIER HEALTHCARE DATA (PINC™ AI)
Author(s)
Rituparna Basu, PhD;
Olympus Corporation of the Americas, Sr Analyst HEOR, Westborough, MA, USA
Olympus Corporation of the Americas, Sr Analyst HEOR, Westborough, MA, USA
OBJECTIVES: Urolithiasis is commonly treated with outpatient lithotripsy using thulium fiber (TFL) or holmium:YAG (HoYAG) lasers; prior comparisons of these lasers lacked nationally representative real‑world cost analyses, so Premier Healthcare Database (PINC™ AI) 2021-2024 was used to compare patient discharge (healthcare) costs while adjusting for socioeconomic, clinical, and facility characteristics.
METHODS: Patients undergoing lithotripsy were identified via CPT codes and laser type determined from billing records; independent variables included socioeconomic (age, gender, payor type, race, ethnicity), clinical (laser type, admission status, Charlson Comorbidity Index, Elixhauser scores, OR time, discharge status), and facility (size, teaching status) measures, with healthcare cost as the outcome. Costs were categorized as ≤50th percentile (low), >50th-≤90th (mid), and >90th (high) and converted to 2024 dollars using the medical care CPI for 2021-2023; analyses comprised descriptive statistics followed by multivariable generalized linear models (GLMs) accounting for clustering, using a normal distribution and identity link, with significance at p<0.05.
RESULTS: From 2021-2024, 137,194 unique encounters were identified; 99.6% (N=136,687) were outpatient, so analyses focused on outpatient encounters. Unadjusted and adjusted analyses found costs were significantly lower for TFL: $ 84 less /discharge in the low-cost group and $533 less / discharge in the high‑cost group (p<0.05), with the GLM difference persisting after covariate adjustment. OR time and teaching hospital status significantly influenced costs in both GLMs, teaching hospitals reporting lower costs. In the low‑cost group, age and Elixhauser score were significant predictors (CCI was not); elective procedures cost $147 less than urgent procedures, and facilities with >500 beds had higher costs. Overall facility size significantly influenced costs.
CONCLUSIONS: Beyond laser type, socioeconomic, clinical, and facility factors significantly influenced lithotripsy healthcare costs, indicating opportunities to reduce costs and improve procedural efficiency that warrant further study.
METHODS: Patients undergoing lithotripsy were identified via CPT codes and laser type determined from billing records; independent variables included socioeconomic (age, gender, payor type, race, ethnicity), clinical (laser type, admission status, Charlson Comorbidity Index, Elixhauser scores, OR time, discharge status), and facility (size, teaching status) measures, with healthcare cost as the outcome. Costs were categorized as ≤50th percentile (low), >50th-≤90th (mid), and >90th (high) and converted to 2024 dollars using the medical care CPI for 2021-2023; analyses comprised descriptive statistics followed by multivariable generalized linear models (GLMs) accounting for clustering, using a normal distribution and identity link, with significance at p<0.05.
RESULTS: From 2021-2024, 137,194 unique encounters were identified; 99.6% (N=136,687) were outpatient, so analyses focused on outpatient encounters. Unadjusted and adjusted analyses found costs were significantly lower for TFL: $ 84 less /discharge in the low-cost group and $533 less / discharge in the high‑cost group (p<0.05), with the GLM difference persisting after covariate adjustment. OR time and teaching hospital status significantly influenced costs in both GLMs, teaching hospitals reporting lower costs. In the low‑cost group, age and Elixhauser score were significant predictors (CCI was not); elective procedures cost $147 less than urgent procedures, and facilities with >500 beds had higher costs. Overall facility size significantly influenced costs.
CONCLUSIONS: Beyond laser type, socioeconomic, clinical, and facility factors significantly influenced lithotripsy healthcare costs, indicating opportunities to reduce costs and improve procedural efficiency that warrant further study.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MT7
Topic
Medical Technologies
Disease
SDC: Urinary/Kidney Disorders, STA: Surgery