| Title: |
A Real-World Cost-Effectiveness Study Evaluating Imaging Strategies for the Diagnostic Workup of Renal Colic in the Emergency Department |
| Authors: |
Kepka, Sabrina; Zarca, Kevin; Ohana, Mickaël; Hoffmann, Anne; Muller, Joris; Le Borgne, Pierrick; Andrès, Emmanuel; Bilbault, Pascal; Durand Zaleski, Isabelle |
| Contributors: |
Service des urgences CHU Strasbourg; Centre Hospitalier Universitaire Strasbourg (CHU Strasbourg); Hôpitaux Universitaires de Strasbourg (HUS)-Hôpitaux Universitaires de Strasbourg (HUS)-Hôpital de Hautepierre Strasbourg; Hôpitaux Universitaires de Strasbourg (HUS); Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube); École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Hôpitaux Universitaires de Strasbourg (HUS)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg); Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE); Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie - CNRS Chimie (INC-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie - CNRS Chimie (INC-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique; Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS); Unité de Recherche Clinique en Economie de la Santé d'Ile-de-France (URC Eco); Hôpital Hôtel-Dieu Paris; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Groupe Henri Mondor-Albert Chenevier; Service de radiologie Strasbourg; Nouvel Hôpital Civil de Strasbourg; Service de Santé Publique CHU Strasbourg; Hôpitaux Universitaires de Strasbourg (HUS)-Hôpitaux Universitaires de Strasbourg (HUS); Nanomédecine Régénérative (NanoRegMed); Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM); Médecine interne CHU Strasbourg; Centre for Research in Epidemiology and Statistics; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); French Emergency Society (SFMU); University Hospital of Strasbourg |
| Source: |
ISSN: 1010-660X. |
| Publisher Information: |
CCSD; MDPI |
| Publication Year: |
2023 |
| Subject Terms: |
urolithiasis; renal colic; cost-effectiveness analysis; emergency department length of stay; ultrasound; tomography; [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology |
| Description: |
International audience ; Introduction: Both non-contrast Computed Tomography (CT) and ultrasound (US) are used for the diagnosis of renal colic in the emergency department (ED). Although US reduces radiation exposure, its diagnostic accuracy is inferior to that of CT. In this context, data regarding the cost and organizational impact of these strategies represent essential elements in the choice of imaging; however, they remain poorly documented. Aim of the study The aim of this study was to compare the costs and effectiveness of diagnostic workup by US and CT for patients consulting with renal colic in the ED. Methods: We conducted a monocentric real-life retrospective study of patients consulting for a renal colic in an ED between 1 July 2018 and 31 December 2018. We estimated length of stay (LOS), total hospital costs at 60 days including ED, and initial and repeat admissions. Patients with initial US in the ED were compared to patients with initial CT using inverse probability weighting of the propensity score calculated from demographic variables, vital parameters, and clinical presentation. We calculated the incremental cost effectiveness ratio as the difference in costs by the difference in LOS. The variability of the results was assessed using non-parametric bootstrapping. Results: In this study, of the 273 patients included, 67 were patients assessed with US and 206 with CT. The average costs were €1159 (SD 1987) and €956 (SD 1462) for US and CT, respectively, and the ED LOS was 8.9 [CI 95% 8.1; 9.4] and 8.7 [CI 95% 7.9; 9.9] hours for US and CT, respectively. CT was associated with a decreased LOS by 0.139 [CI 95% -1.1; 1.5] hours and was cost-saving, with a €199 [CI 95% -745; 285] reduction per patient. Conclusion: When imaging is required in the ED for suspected renal colic as recommended, there is real-life evidence that CT is a cost-effective strategy compared to US, reducing costs and LOS in the ED. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/36984476; PUBMED: 36984476; PUBMEDCENTRAL: PMC10058030 |
| DOI: |
10.3390/medicina59030475 |
| Availability: |
https://univoak.hal.science/hal-05502149; https://univoak.hal.science/hal-05502149v1/document; https://univoak.hal.science/hal-05502149v1/file/Kepka%20et%20al.%20-%202023%20-%20A%20Real-World%20Cost-Effectiveness%20Study%20Evaluating%20Imaging%20Strategies%20for%20the%20Diagnostic%20Workup%20of%20Ren.pdf; https://doi.org/10.3390/medicina59030475 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ ; info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.E32CBDB |
| Database: |
BASE |