Mp43-02 patients on Medical Expulsive Therapy for Obstructing Ureterolithiasis - The Wisconsin Stone Quality of Life (Wisqol) Survey

Abstract

Alpha-blocker medical expulsive therapy (MET) is widely utilized in the treatment of ureteral stones though its effectiveness is questionable. With increasing burden of urolithiasis on US healthcare, the utilization effects of a-blocker therapy have not been elucidated. We studied the effects of a-blocker MET in reducing surgical intervention, imaging, adverse events, ER visits, and cost up to 3 months.METHODS: Patients were selected from a US national commercial claims database between 2011 and 2016 based on prescription of a-blocker for a primary diagnosis of ureteral stone in an emergency room (ER), urgent care, outpatient, or inpatient hospital setting. We identified 58568 patients with and 78653 patients without prescription for alpha-blocker. Evaluation was performed at 30 days and 90 days after diagnosis of a ureteral stone event to determine rate of surgical intervention, number and type of follow-up imaging studies, adverse events, ER visits, and total medical claims cost. Multivariable linear and logistic regression models were used to test associations between outcome variables and the use of MET.RESULTS: a-blockers were prescribed to 43% of patients with ureteral stones for median length of 14 days. At 30-days after index stone event, 20.6% MET vs. 20.1% non-MET (p<0.001, OR[1.07) underwent a surgical procedure, 40% MET vs. 32% non-MET (p<0.001, OR[1.46) had a follow-up imaging study (KUB, CT or US scan) and 20% MET vs. 16% non- MET (p<0.001, OR[1.36) presented to the ER. Total medical claims cost at 30 days was $3860