Is the Economic Impact and Utilization of Imaging Studies for Pediatric Urolithiasis Across the United States Increasing?

Abstract

Objective To identify longitudinal trends of economic impact and resource utilization for management of pediatric urolithiasis using national databases. Methods We analyzed the 2006-2012 Nationwide Emergency Department Sample and Nationwide Inpatient Sample. We used ICD-9 codes to identify patients (≤18 y) diagnosed with urolithiasis. Diagnostic imaging and surgeries were identified using ICD-9 and CPT codes. We abstracted demographic, imaging, procedure, and charge data. Weighted descriptive statistics were calculated to describe the population's demographics and economic expenditures by clinical setting and year. Results In total, 45,333 inpatient admissions (68% females) and 234,559 ED encounters (63% females) were identified. Most patients (84%) were teenagers and the southern region of the United States was the most common geographic region for all encounters (44%). There was no significant trend in number of urolithiasis encounters over the period studied. Utilization of all imaging techniques increased; in particular, CT was used in 23% of encounters in 2006 and 40% in 2012 (p<0.0001). The mean charge per ED visit increased by 60% from $3,645 in 2006 to $5,827 in 2012 (p<0.0001). The mean charge increased for inpatient admissions by 102%, from $16,399 in 2006 to $33,205 in 2012 (p<0.0001). Total charges increased 72% over the study period from $230 million in 2006 to $395 million in 2012 (p<0.0001), outpacing medical inflation over the same period. Conclusions Charges for pediatric urolithiasis management increased by 65% from 2006-2012 despite stable frequency of patient encounters. The utilization of CT in pediatric urolithiasis increased as well.

Urology Consultation and Emergency Department Revisits for Children with Urinary Stone Disease

“…1,2 During this time, the increase in healthcare costs for pediatric stone disease has outpaced medical inflation; and the amount of healthcare dollars spent on it has quadrupled. 3,4 The shift in disease onset to childhood means that pediatric providers must evaluate and treat a previously uncommon condition with limited evidence to inform care. This increases the possibility of over or under testing, unnecessary irradiation, and inappropriate health services utilization, such as emergency department (ED) revisits.…”