Objectives: To perform a cost-benefit analysis comparing Total Laparoscopic Retroperitoneoscopic Donor Nephrectomy (TLRPDN) and Hand-Assisted Laparoscopic Donor Nephrectomy (HALDN) at a single transplant centre and to provide context for the cost-effectiveness of these techniques compared to Robotic-Assisted Donor Nephrectomy (RADN).
Study Design: A retrospective cohort study.
Setting: A busy transplant centre in the United Kingdom.
Participants: 173 patients who underwent minimal access donor nephrectomies (137 TLRPDN and 35 HALDN) between December 2011 and January 2020. Donor characteristics, including age, BMI, PCA time, and hospital stay, were compared between the two groups.
Methods: A micro-costing approach was used to estimate the costs from the hospital perspective. Cost estimates included sterilisation costs for multiple-use equipment, purchasing costs for single-use equipment, staff, hospital stay, intraoperative medications, and post-operative analgesia. Quality-Adjusted Life Years (QALY) were assessed at 1-year post-operatively and annually thereafter. Published average cost figures of RADN were used to provide context for the cost-effectiveness of TLRPDN and HALDN.
Results: Donor characteristics were similar in both groups. The average cost for a single non-complicated TLRPDN was $12,203 (theatre: $6,444, ward-stay: $4,968, other: $791), while the average cost for a single non-complicated HALDN was $13,390 (theatre: $7,251, ward-stay: $4,967, other: $1,172). In comparison, the US data quotes the average RADN theatre alone costs at $8,913. The average QALY at 1 and 3 years was 0.84/2.54 for TLRPDN and 0.79/2.32 for HALDN. The QALY gained with TLRPDN was 0.22, with a cost per QALY gained of $2,551.
Conclusion: TLRPDN provides a cost-benefit compared to HALDN. While RADN theatre costs appear higher, more comprehensive costing data needs to be published to facilitate further comparisons between minimally invasive donor nephrectomy techniques.