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As worldwide economies the struggle with the cost of healthcare, using epidemiological tools will continue to be a critical mechanism towards effective and fiscally rational solutions. Lotan et al. have added to our fund of knowledge in this movement and used a sophisticated decision model (Markov model) to calculate and compare the payer costs and outcomes for a theoretical cohort of subjects using the most basic conservative management for kidney stone disease, i.e. increased water intake. This model showed that adoption of increased water intake of ≥2 L/day could theoretically provide payer savings from €68 billion (assumes 25% compliance) to €273 billion (assumes 100% compliance).

As with any analysis the assumptions underlying the study are critical and the study therefore used reliable epidemiological data for clinical parameters (stone incidence, risk reduction with water intake, stone recurrence, etc.). As the analysis assumed costs based on French healthcare, the results may not be applicable to many regions. However, a brief review of the French costs (Urology consultation €23 equates to $30 USD) suggests that healthcare costs in other systems, such as the USA, are much higher. It therefore may be safe to assume that cost savings would be even more dramatic in these healthcare systems.

Limitations aside, healthcare costs are complex and this study used conservative assumptions, which arguably underestimate the benefit in this model. And if valid, these findings underscore the importance of the most basic education we should and have been giving our stone patients – drink more water.