Cost effectiveness of laparoscopic versus mini-incision open donor nephrectomy: a randomized study.
BACKGROUND
Cost-effectiveness remains an issue surrounding the introduction of laparoscopic donor nephrectomy (LDN).


METHODS
In a randomized controlled trial the cost-effectiveness of LDN versus mini-incision open donor nephrectomy (ODN) was determined. Fifty donors were included in each group. All in-hospital costs were documented. Postoperatively, case record forms were sent to the donors during 1-year follow-up to record return-to-work and societal costs. To offset costs against quality of life, the Euroqol-5D questionnaire was administered preoperatively and 3, 7, 14, 28, 90, 180, and 365 days postoperatively.


RESULTS
Mean total costs were euro6,090 (US$7,308) after LDN and euro4,818 ($5,782) after ODN (P<0.001). Disposables influenced the cost difference most. Mean productivity loss was 68 and 75 days after LDN and ODN respectively, corresponding to euro783 ($940) gained per donor after LDN. The main gain in quality of life in the LDN group was realized within 4 weeks postoperatively. LDN resulted in a mean gain of 0.03 quality-adjusted life years at mean costs of euro1,271 ($1,525) and euro488 ($586) from a healthcare perspective and a societal perspective, respectively. This implies that one additional Quality-Adjusted Life Year after LDN costs about euro16,000 ($19,200) from a societal point of view and about euro41,000 ($49,200) from a health-care perspective. Activities other than work were resumed significantly earlier after LDN (66 vs. 91 days, P=0.01).


CONCLUSIONS
In addition to a clinically relevant donor-experienced benefit from LDN, this technique appeared, given a societal perspective, a cost-efficient procedure mainly due to less productivity losses.
Kok
Niels F M
NF
Department of Surgery, Erasmus MC, and Department of Medical Technology Assessment, Radboud University Medical Center, Nijmegen, The Netherlands.
Adang
Eddy M M
EM
Hansson
Birgitta M E
BM
Dooper
Ine M
IM
Weimar
Willem
W
van der Wilt
Gert-Jan
GJ
Ijzermans
Jan N M
JN
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D004651:Employment; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics* / Q000534:rehabilitation; D009426:Netherlands; D011788:Quality of Life; D013997:Time Factors