Cost effectiveness of open versus laparoscopic living-donor nephrectomy.
BACKGROUND
Kidney transplantation is an essential part of care for patients with end-stage renal disease. The introduction of laparoscopic living-donor nephrectomy (LLDN) has made live donation more advantageous because of less postoperative pain, earlier return to normal activities, and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN.


METHODS
Kidney donors were randomized to laparoscopic (n=63) or open surgery (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated into utilities by means of Brazier's 6D algorithm.


RESULTS
The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0.780 and 0.765, respectively for laparoscopic and open surgery. This implies a cost of U.S. $1,693,733 per QALY at 12 months follow-up. Sensitivity analyses indicated that the cost of the major complications in the laparoscopic group and magnitude of QALY gain had the greatest impact on cost effectiveness.


CONCLUSIONS
The LLDN is an attractive alternative because it, in general, entails less postoperative pain than open surgery, but it is cost effective only with relatively low rates of complications.
Hamidi
Vida
V
Health economics and drugs unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway. vida.hamidi@kunnskapssenteret.no
Andersen
Marit Helen
MH
Oyen
Ole
O
Mathisen
Lars
L
Fosse
Erik
E
Kristiansen
Ivar Sønbø
IS
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004651:Employment / Q000191:economics; D005190:Family; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics*; D009664:Norway; D011183:Postoperative Complications / Q000191:economics; D011897:Random Allocation; D012077:Renal Artery / Q000601:surgery; D012086:Reoperation / Q000191:economics; D020858:Tissue and Organ Harvesting / Q000191:economics* / Q000379:methods