« Make healthy hydration the new norm »

Lotan Y. et al. 2012

Primary prevention of nephrolithiasis is cost-effective for a national healthcare system

Summary provided by Prof. Yair Lotan, Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Download the summary


One of the major problems with nephrolithiasis is the high rate of recurrence, which can effect up to 50% of patients over a 5-year period. Patients with recurrent stones are recommended to increase fluid intake based on prospective studies that show a reduction in recurrence rates in patients who intake a high volume of water. Unfortunately, despite a high societal cost and morbidity, there are no prospective studies evaluating the benefit of fluid intake to prevent stone disease in subjects without a prior history of stone but at risk for stones. The goal of this study was to evaluate the financial impact of primary prevention of stones using a strategy of increased fluid intake. A Markov model was constructed and analysed using Excel to calculate and compare the costs and outcomes for a virtual cohort of subjects with low vs high water intake.

Key findings

The base-case analysis found that the total cost of urolithiasis is €4267 with direct costs of €2767, including cost of treatment and complications. The annual budget impact for stone disease based on 65 million inhabitants is €590 million for the payer. Use of high water intake by 100% of the population results in annual cost savings of €273 million and 9265 fewer stones. Even if only 25% of the population is compliant, there is still a cost saving of €68 million and 2316 stones.

Relevance for healthy hydration

The budget impact analyses show that prevention of nephrolithiasis can have significant cost savings for a payer in a healthcare system and reduce the stone burden significantly. Future studies will need to assess the feasibility and effectiveness of such an approach in a population.

Lotan Y, Buendia Jiménez I, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ, Primary prevention of nephrolithiasis is cost-effective for a national healthcare system. BJU Int. 2012 Jun 11. doi: 10.1111/j.1464-410X.2012.11212.x. [Epub ahead of print]