요로결석의 치료방법에 따른 결과 및 경제성에 대한 비교

Abstract

[한글]

체외 충격파 쇄석기의 개발이후 체외충격파 쇄석술의 치료 효과와 안전성 등의 잇점에 대하여는 이미 국내외의 많은 보고가 있으나, 국내의 현실 여건상 고가의 장비 사용과 의료보험이 적응되지 않는 점등으로 다른 치료 방법 에 비하여 월등히 비용이 많이 드는 것

으로 인식되어 있다. 1987년 8월부터 1990넌 2웜까지 세브란스 병원 비뇨기과에 내원한 총 1,507명의 요로결석 환자 중에서 요관경하배석술 또는 체외충격파 쇄석술을 시행하였던 각각 60명의 하부요관결석 환자와 관혈적 절석술, 경피적 신쇄석술 또는 체외 충격파 쇄석술을 시행하였던 신결석 환자 각각 60명을 대상으로 치료방법에 따라 치료 결과와 비용을 비교하여 다음과 같은 결론을 얻었다.

1. 총 요로결석 환자 1,507명 중 68.7%인 1,035명에서 일차적 치료 방법으로 체외충격파 쇄석술을 시행하였다.

2. 하부요관 결석 치료군의 비교.

요관경하 배석술 치료군과 체외충격파 쇄석술 치료군 사이에 치료 성공률의 차이는 없었으며 입원 기간은 체외충격파 쇄석술 치료군의 경우가 짧았으나 총비용은 체외충격파 쇄석술 치료군이 높았다.

3. 신결석 치료군의 비교.

관혈적 절석술 치료군, 경피적 신쇄석술 치료군, 체외충격파 쇄석술 치료군의 성공률은 유사하였고, 입원 기간은 체외 충격파 쇄석술 치료군이 다른 두 가지 치료군에 비하여 월등히 짧았으며 총비용은 모두 비슷하였다. 단지 보험 적용의 유무에 따른 환자 본인 부담액은 체외충격파 쇄석술 치료군이 관혈적 절석술 치료군 또는 경피적 신쇄석술 치료군에 비하며 높았다.

이상의 결과로 보아, 입원 기간과 퇴원 후 정살 사회활동까지의 노동력 손실로 인한 간접비용을 고려하면 체외충격파 쇄석술이 보다 경제적인 치료방법으로 생각되며 체외충격파 쇄석술에도 보험이 적용되고 국내의 제외충격파 쇄석기의 가동률을 높여 장비사용 단

가를 낮춘다면 체외충격파 쇄석술은 더욱 경제적인 치료법이 될 수 있을 것이다.

Comparisons of Results and Cost of Treatment Modalities in Urinary Tract Calculi

Hak Ryong Choi

Department of Medical Science, The Graduate School, Yonsei University

(Directed by professor Moo Sang Lee, M.D.)

Since the development of extracorporeal shock-wave lithotripsy there have been

many articles about the benefits of it. But in Korea, the extracorporeal shock-wave

lithotripsy is considered to be a more costly method than other treatment

modalities because extracorporeal shock- wave lithotriptor itself is very expensive

and extracorporeal shock-wave lithotripsy is not covered by medical insurance. From

August 1987 to February 1990 1,507 urinary tract calculi patient shave visited

severance hospital and among them 1,035 patients have received extracorporeal

shock-wave lithotripsy as the primary treatment choice. The success rates and cost

of each treatment methods were compared between URS and ESWL in ureteral stone

patients and between open surgery, PNL and ESWL in renal stone patients.

There was no difference in success ratea between URS and ESWL and the cost of

ESWL was higher than that of URS in lower ureter stone patients. The admission stay

of ESWL treated group was shorter than that of URS treated group. The overall

success rates and total cost in renal stone patients were similar between open

surgery, PNL and ESWL. Considering the period of admission and recovery day, ESWL

is the more economic method in renal stone patients. Because the ESWL is not

covered by medical insurance, self cost(which patients directly pays) is higher

than other methods.

If ESWL become medically insurable and the working ratio of the equipment is

promoted, ESWL will be a more economic method in Korea.

[영문]

Since the development of extracorporeal shock-wave lithotripsy there have been many articles about the benefits of it. But in Korea, the extracorporeal shock-wave lithotripsy is considered to be a more costly method than other treatment modalities because extracorporeal shock- wave lithotriptor itself is very expensive

and extracorporeal shock-wave lithotripsy is not covered by medical insurance. From August 1987 to February 1990 1,507 urinary tract calculi patient shave visited severance hospital and among them 1,035 patients have received extracorporeal

shock-wave lithotripsy as the primary treatment choice. The success rates and cost of each treatment methods were compared between URS and ESWL in ureteral stone patients and between open surgery, PNL and ESWL in renal stone patients.

There was no difference in success ratea between URS and ESWL and the cost of ESWL was higher than that of URS in lower ureter stone patients. The admission stay of ESWL treated group was shorter than that of URS treated group. The overall success rates and total cost in renal stone patients were similar between open

surgery, PNL and ESWL. Considering the period of admission and recovery day, ESWL is the more economic method in renal stone patients. Because the ESWL is not covered by medical insurance, self cost(which patients directly pays) is higher than other methods.

If ESWL become medically insurable and the working ratio of the equipment is promoted, ESWL will be a more economic method in Korea.