Urinary Calculi Care Pathways in a French Nationwide Study: The Costs, Lithiasis and Pathways (CLiPs) Study

Urinary stone treatment is of interest from a health-economic point of view because of competing technical approaches, high incidence and high recurrence rates. In France, since the release of the activity-based funding called T2A (for Tarification A l'Activité), concerns about possibly induced overactivity have been increasing. A flat-sum-based payment per stone episode has even been proposed. This study aims to describe different parameters, such as reintervention rates. Using the linkage between different stays of one patient, we studied multiple stays and procedures in the extensive reimbursement database of a group of nationwide private clinics. Patients were identified in 2020, and their procedures and stays were studied in 2019, 2020 and 2021. Demographic data, number of stays and interventions, number of multiple interventions, number of ureteral stentings without other procedures and the rate of outpatient stays were collected. We obtained 50,295 stays from 31,209 patients (0.52 female/male). The median age of the patients was 54 years. The average number of stays was 1.6. No intervention was performed in 16% of the patients. Shockwave lithotripsy (SWL) and ureteroscopy (URS) were performed in 24.7% and 63.3% of the patients, respectively. After one primary URS, 3.2% of the patients were treated with 1.3 SWL on the average, and 24.2% were treated with 1.3 URS on the average. Percutaneous nephrolithotomy with first intent was marginal in the sample, and local disparities were rare. In this representative sample, despite true limitations, repeated procedures were less frequent than expected.