Is prevention of stone recurrence financially worthwhile?

This review shows that the cost of relying solely on minimally-invasive urological procedures for removing stones when patients return with recurrent stones is considerable and is significantly greater that that incurred by screening already proven recurrent stone-formers to identify the risk factors that are causing their stones and then instituting prophylactic measures to prevent stone recurrence. In the UK, at 1998 prices (when the original survey was carried out) for every stone episode prevented, there is a potential saving of almost £2,000 to the local Health Authority concerned. In spite of this, many Health Authorities have taken the liberty to discontinue comprehensive stone screening within the past 20 years under the mistaken supposition that minimally-invasive techniques for removing stones have “solved the stone problem”. At UCLH in London where such a comprehensive scheme has been in place for the past 8 years, savings of up to £250,000 per year can be made by identifying the particular lifestyle as well as the epidemiological, metabolic and nutritional risk factors involved in a given patient and then instituting appropriate measures to prevent further stones.