OPERATING ROOM EFFICIENCY AND COST IMPLICATIONS OF THULIUM FIBER LASER VERSUS HOLMIUM:YAG LASER FOR URETEROSCOPIC LITHOTRIPSY: A TARGETED REVIEW, ANALYSIS, AND MODEL
Author(s)
Timothy Kelly, MBA, MSc1, Ashley Taneja, BS2, Vy Giang, PharmD, MBA2, MONICA TELINOIU, MBA, MS2;
1Becton Dickinson, Senior Director HEOR, Atlanta, GA, USA, 2Becton Dickinson, Franklin Lakes, NJ, USA
1Becton Dickinson, Senior Director HEOR, Atlanta, GA, USA, 2Becton Dickinson, Franklin Lakes, NJ, USA
OBJECTIVES: The holmium:yttrium aluminum garnet (Ho:YAG) laser has long been considered the gold standard for ureteroscopic lithotripsy. The evolution of laser technology in the search for a more efficient option sparked the emergence of the thulium fiber laser (TFL). In vitro studies suggest that TFL provides several technical advantages over Ho:YAG, including lower stone ablation thresholds, minimized tissue damage, and a wider range of laser settings. This review and analysis seek to determine whether TFL demonstrates greater efficiency in terms of procedure duration and also stone clearance.
METHODS: A targeted review of original research published 2021 through 2025 (PubMed) for studies comparing Ho:YAG to TFL ureteroscopic lithotripsy and reporting total operative time was conducted. The study results on operative time difference were synthesized and incorporated into an economic model to estimate the potential cost savings resulting from a reduction in total operative time.
RESULTS: 115 records were identified. After exclusions, 98 records were reviewed, and 16 were analyzed. Reported differences in total operative time between cases comparing the two lasers ranged from 3 minutes faster with Ho:YAG to 18.5 minutes faster with TFL. Across all included studies, operative time differences were aggregated to calculate a pooled mean reduction of 7.9 minutes for TFL procedures. This reduction was applied to an economic model based on standard operating room cost assumptions, estimating a per-case cost savings of $386 (2025 USD). Of the 15 studies reporting stone-free rates, 14 demonstrated equivalent or superior outcomes for patients treated with TFL.
CONCLUSIONS: Ureteroscopic laser lithotripsy procedures performed with TFL may reduce total operating room time by approximately 8 minutes per case. That time savings represents a $386 per-case cost savings over procedures performed with a Ho:YAG laser. In addition, the use of TFL may be associated with equal or improved stone-free rates at one month or later post-procedure.
METHODS: A targeted review of original research published 2021 through 2025 (PubMed) for studies comparing Ho:YAG to TFL ureteroscopic lithotripsy and reporting total operative time was conducted. The study results on operative time difference were synthesized and incorporated into an economic model to estimate the potential cost savings resulting from a reduction in total operative time.
RESULTS: 115 records were identified. After exclusions, 98 records were reviewed, and 16 were analyzed. Reported differences in total operative time between cases comparing the two lasers ranged from 3 minutes faster with Ho:YAG to 18.5 minutes faster with TFL. Across all included studies, operative time differences were aggregated to calculate a pooled mean reduction of 7.9 minutes for TFL procedures. This reduction was applied to an economic model based on standard operating room cost assumptions, estimating a per-case cost savings of $386 (2025 USD). Of the 15 studies reporting stone-free rates, 14 demonstrated equivalent or superior outcomes for patients treated with TFL.
CONCLUSIONS: Ureteroscopic laser lithotripsy procedures performed with TFL may reduce total operating room time by approximately 8 minutes per case. That time savings represents a $386 per-case cost savings over procedures performed with a Ho:YAG laser. In addition, the use of TFL may be associated with equal or improved stone-free rates at one month or later post-procedure.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE88
Topic
Economic Evaluation
Disease
SDC: Urinary/Kidney Disorders, STA: Surgery