Authors' objectives:

To summarise and critically analyse the scientific information on lithotripsy, predict the future development of this technology and give recommendations for the optimal diffusion of lithotripsy in Sweden.

Authors' results and conclusions: The first kidney lithotripter was installed in Sweden in 1985 and by 1990, seven hospitals had acquired lithotripsy. The annual operational and capital cost for each unit in Sweden was 5.5-7.0 million SEK in 1990. The cost per treatment was 7000 SEK and the total cost for the complete therapy including examination with cholecystography and 3 days hospital stay was 17000 SEK. The chemolytic treatment during the subsequent year following treatment is about 11500 SEK. The cost of the alternative with open surgery is 30000 SEK. The expected costs per patient are about equal (approximately 30000 SEK) for all alternatives (cholecystectomy, chemolytic therapy, lithotripsy) at a 10% discount rate. The costs also depend on the size of the stones.

Authors' recommendations: Lithotripsy is less painful and less risky than open surgery, offers a shorter stay in hospital and a shorter absence from work. It should therefore replace open surgery. In the future, equipment will be smaller, simpler and cheaper. Caution is urged for those planning to invest in lithotripsy that the technology will change rapidly. The indications for treatment may also broaden. More research is required regarding the side effect of lithotripsy including hypertension and other effects of the residual kidney stones. It is important to compare results from different centres with different treatment. An internationally accepted classification system should be introduced to allow assessment of the outcomes. Alternatives treatment to lithotripsy are percutaneous kidney surgery and minimally invasive surgery. It is recommended that resources be concentrated on 2 lithotripsy units in Sweden which will assume the responsibility for education on this technology. Treatment of the gallbladder with lithotripsy must be tested further in RCT studies before introducing the method in clinical practice. The consequent structural and organisational changes that result from the introduction of lithotripsy should be analysed.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 1989

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: The Swedish Council on Technology Assessment in Health Care