title: Comparison of open live donor nephrectomy, laparoscopic live donor nephrectomy, and hand-assisted live donor nephrectomy: a cost-minimization analysis.
abstract: BACKGROUND
  Live donor kidney transplantation is the treatment of choice for end-stage renal disease. Open donor nephrectomy (ODN) was the standard until the introduction of the laparoscopic donor nephrectomy (LDN) in 1995. Hand-assisted laparoscopic donor nephrectomy (HALDN) was added shortly thereafter. The laparoscopic techniques are associated with increased operating room times and equipment costs; however, these techniques speed patient return to normal activity. The aim of this study is to evaluate the cost of these techniques.
  
  
  METHODS
  A decision analysis model was developed to simulate outcomes for donors undergoing ODN, LDN, and HALDN. Outcomes were simulated from both the institutional perspective (IP) and the societal perspective (SP). Baseline values and ranges were determined from a systematic review of the literature. Sensitivity analyses were conducted to test model strength.
  
  
  RESULTS
  From the IP, ODN is the least costly strategy with a cost of $11,000, while the cost is $15,200 for HALDN and $15,800 for LDN. From the SP, HALDN is the least costly strategy costing $27,800, while the cost for LDN is $29,000 and for ODN is $41,000. In sensitivity analysis, ODN only became the dominant strategy if the days till return to work exceeded 58 in the HALDN strategy. LDN and HALDN were nearly equivalent as the rate of open conversion of LDN approached zero.
  
  
  CONCLUSIONS
  HALDN is the least costly donor nephrectomy strategy, especially from the SP. The primary determinants of cost in this model are conversion to open and days till return to work.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Dageforde
authors.forename: Deonna R
authors.initials: DR
authors.lastname: Moore
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Landman
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson
authors.forename: Benjamin
authors.initials: B
authors.lastname: Poulose
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Derek E
authors.initials: DE
authors.lastname: Moore
mesh_terms: D000328:Adult; D017046:Cost Savings; D003663:Decision Trees; D004651:Employment / Q000191:economics; D005260:Female; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000601:surgery*; D016030:Kidney Transplantation / Q000191:economics* / Q000379:methods*; D019520:Living Donors; D017059:Models, Econometric; D009392:Nephrectomy / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics; D018582:Sick Leave / Q000191:economics