Supoj Ratchanon, MD¹ , Nonthana Assawawitoontip, MD² , Swiss Suharitdumrong, MD² , Apirak Santingamkun, MD¹

Background: Urolithiasis is common in Thailand, particularly in the northeast. Extracorporeal shock wave lithotripsy (ESWL) is a widely used noninvasive treatment for renal calculi. Smart Litho Plus, a Thai-manufactured electromagnetic lithotripter, was developed as a lower-cost alternative to imported systems, but its cost-effectiveness has not been formally evaluated.

Objective: To compare the cost-utility of Smart Litho Plus with a standard imported electromagnetic ESWL system for renal calculi in Thailand, from healthcare provider and societal perspectives.

Materials and Methods: A model-based cost-utility analysis was conducted using head-to-head effectiveness data from a 121-patient multicenter retrospective cohort. The base case used a 10-year decision-analytic cohort model, extended to a lifetime Markov model. Costs and outcomes were discounted at 3% annually, following Thai HITAP guidance. The willingness-to-pay threshold was 160,000 THB per quality-adjusted life year (QALY). Uncertainty was assessed using deterministic sensitivity analysis, threshold analyses, two-way analysis, and probabilistic sensitivity analysis with 10,000 Monte Carlo simulations. Reporting followed CHEERS 2022.

Results: In the base case, Standard ESWL dominated Smart Litho Plus under both perspectives, being less costly and more effective. From the provider perspective, total costs were 124.4 million THB for Standard ESWL and 140.3 million THB for Smart Litho Plus, while Standard ESWL gained 6.15 additional QALYs. Cost per case was 70,786 THB versus 79,839 THB. In probabilistic analysis, Standard ESWL had a 76.8% probability of strict dominance and an 81.0% probability of being cost-effective. Smart Litho Plus became cost-effective only if its stone-free rate increased from 44% to approximately 53%.

Conclusion: Despite its lower purchase price, Smart Litho Plus was dominated by Standard ESWL because lower effectiveness led to higher downstream salvage costs.

Received 9 July 2026 | Revised 4 August 2026 | Accepted 17 August 2026

J Med Assoc Thai 2026;109(9):746-57

DOI: 10.35755/jmedassocthai.2026.9.04864