OBJECTIVES : Temporary ureteral stent placement is commonly performed after ureteroscopy for stone disease. While the stents can be removed by extraction string, it is unknown if removal via cystoscopy would incur higher healthcare costs. This study examined the economic burden associated with cystoscopy-based stent removal (CBSR) following ureteroscopy.

METHODS : A retrospective cohort study was conducted using IBM^® MarketScan^® Commercial database, including large convenient samples of US working population, from January 2014 to June 2018. We identified patients aged ≥18 years who had stent placement post-ureteroscopic laser lithotripsy for stone treatment and categorized them as those with and without CBSR within 6 months post-index surgery. To estimate the economic burden, average medical costs at 6 months were calculated and adjusted to 2019 USD. We used the generalized linear model (GLM) with gamma distribution and log link to estimate the effect of CBSR on medical costs adjusting for patient demographics and comorbidity profiles. The analysis was completed using the Instant Health Data platform.

RESULTS : Out of the 29,536 patients with stent placement, 56.5% had CBSR within 6 months. The median time to CBSR was 9 days; 69.8% occurred in office. A majority of CBSR and non-CBSR patients were males, aged 35-54 years, and had a previous stone diagnosis 6 months pre-index surgery. Average 6-month medical costs for CBSR patients were significantly higher than non-CBSR patients ($7,808 vs $6,231; p<0.0001). The difference was driven by the costs of CBSR ($1,132 vs $0; p<0.0001) and healthcare utilizations for stone disease ($2,464 vs $2,121; p<0.0001). CBSR was significantly associated with 1.2 times increase in medical costs over 6 months compared to non-CBSR after adjusting for other covariates (p<0.0001).

CONCLUSIONS : CBSR following ureteroscopy increases the economic burden among stone patients. Ureteral stents that reduce the need for CBSR may result in lowering medical costs to the US healthcare system.