Costs of Resolving a Ureteral or Kidney Stone Episode Worldwide: A Systematic Review

The same kidney stone operation (PCNL) costs anywhere from $165 to $101,510 depending on where it's done — a 615-fold gap that makes cost comparisons nearly meaningless

Journal: International Urology and Nephrology | Published: 2025-09-15 | Type: Systematic Review | PMID: 40952639 Authors: Zekraoui O, Moussa I, Lee N, Nguyen D-D, Guennoun A, Bouhadana D, Murad L, Siron N, Chen K, Bhojani N (Université de Montréal, McGill University, University of Toronto) Funding/COI: Funding not disclosed. Lead author Bhojani is a consultant for Olympus, Boston Scientific, and Procept BioRobotics — all manufacturers of endoscopic and stone-management equipment directly relevant to the procedures reviewed.

Summary

Urolithiasis treatment is a massive global cost driver and nobody agrees on how to measure it. This systematic review pulled 38 studies from 13 countries, inflated and converted everything to 2024 USD, and found cost ranges so wide they defy comparison: percutaneous nephrolithotomy (PCNL) alone spans $165 to $101,510. The core finding is methodological: cost reporting is so inconsistent across studies that no reliable cross-country comparison is possible.

Claims

• URS (ureteroscopy) costs ranged from $249 to $48,937 across studies
• ESWL (shockwave lithotripsy) costs ranged from $177 to $10,185
• PCNL costs showed the largest spread: $164 to $101,510 — a 615-fold difference
• Medical expulsive therapy (MET) costs ranged from $294 to $17,982
• 17 of 38 studies (45%) did not define "stone-free status" — the primary outcome the costs are supposed to achieve
• 2,461 references screened; 38 studies from 13 countries met inclusion criteria (2014–2024)

Study Quality

This is a systematic review of economic studies, not a meta-analysis of clinical outcomes — it cannot pool effect sizes or produce a summary cost estimate, and it doesn't try to. The search was appropriately broad (Medline, EMBASE, Web of Science), the inclusion criteria required actual monetary values and described cost components, and the inflation-to-2024-USD standardization is a reasonable comparability attempt. That said, the authors themselves admit the heterogeneity is so extreme that qualitative synthesis is all that's possible.

The 10-year window (2014–2024) is sensible. Restricting to adult patients is standard. However, 38 studies across 13 countries for a condition affecting 115 million people globally is a thin base for policy recommendations. The full-text sections provided with this paper appear to be from a separate GBD epidemiology study rather than the cost review itself, which limited independent methodology verification beyond the abstract.

Red Flags

• Lead author conflict of interest: Bhojani consults for Olympus, Boston Scientific, and Procept BioRobotics — companies that make the scopes and lithotripsy equipment used in the very procedures being cost-analyzed. Not disqualifying, but notable.
• Funding not disclosed: A systematic review from five academic centers has no disclosed funding source. That absence is itself information.
• 45% of included studies undefined "stone-free": The endpoint that justifies the cost was undefined in nearly half the evidence base. Comparing procedure costs without a shared success definition is comparing apples to surgical trays.
• Cost component definitions varied wildly: Procedural costs, hospital stay, anesthesia, re-treatment, and follow-up imaging were inconsistently included or excluded across studies — the ranges likely reflect accounting differences as much as true price variation.
• No quality-adjusted outcomes: No QALY, no cost-effectiveness ratio, no incremental analysis. This is cost enumeration, not health economics.
• 13 countries out of 195: The global framing is aspirational; the evidence is from a narrow slice, heavily weighted toward high-income settings.

Strengths

• Correctly diagnoses the core problem: methodological chaos, not just price variation
• Proposes standardization recommendations — the paper is most useful as a call for consensus on how future economic studies should be designed
• Currency inflation and conversion to 2024 USD is the right move for cross-study comparability
• Explicitly flags COI in the disclosure section, which many systematic reviews bury or omit

Verdict

This paper is more valuable as a diagnostic than a reference. It documents, rigorously, that the existing cost literature for kidney stone treatment is too fragmented to support cross-country comparisons or cost-effectiveness conclusions. If you want a single number for what PCNL costs, this paper tells you that number doesn't exist in any defensible form. The conflict of interest from device industry consulting doesn't taint the findings here — the conclusion is essentially "we can't conclude anything" — but future work from this group on which procedure is most cost-effective should be read with that in mind.