A cost-utility analysis

Background: As compared with open donor nephrectomy (OpenDN), laparoscopic donor nephrectomy (LapDN) offers donors more rapid recovery and recipients equivalent graft function, but LapDN costs remain greater. This study compared LapDN and OpenDN with cost–utility analysis. Methods: Utilities were assessed with time trade-off, probabilities derived from systematic review of the literature and the costs derived from 27 OpenDN and 34 LapDN patients treated contemporaneously. A societal perspective was taken. Lost employment costs were included. An incremental cost-effectiveness ratio (ICER) was calculated with best- and worst-case scenarios for confidence intervals. Sensitivity analyses assessed robustness. Results: LapDN costs are lower ($11,170.71 vs $12,631.91), whereas quality of life (QOL) is superior (0.7247 vs 0.6585 quality-adjusted life years [QALY], rendering LapDN a dominant strategy. The model was robust to all variables, and LapDN remained dominant from a payer perspective. In a worst-case scenario, the ICER for LapDN was at most $2,231.61 per QALY. Conclusions: LapDN offers improved QOL at lower costs, despite the fact that this analysis included patients treated during the learning curve of LapDN at our institution. By potentially increasing organ donor rates, LapDN may be further cost saving by decreasing the number of patients receiving dialysis.

[1]  P. Matz.  Editorial comment--Spontaneous subarachnoid hemorrhage: volume, experience, and outcome. , 2003, Stroke.

[2]  P. Enblad,et al.  Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care* , 2002, Critical care medicine.

[3]  Naomi S. Bardach,et al.  Association Between Subarachnoid Hemorrhage Outcomes and Number of Cases Treated at California Hospitals , 2002, Stroke.

[4]  C. Contant,et al.  Changes in Intervention and Outcome in Elderly Patients With Subarachnoid Hemorrhage , 2001, Stroke.

[5]  J. Goldstone,et al.  Medical repatriation via fixed‐wing air ambulance: a review of patient characteristics and adverse events , 2001, Anaesthesia.

[6]  J. Wolf,et al.  Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. , 2001, Transplantation.

[7]  J. Barry.  Laparoscopic donor nephrectomy: con. , 2000, Transplantation.

[8]  M. Rajasekar,et al.  Challenges in laparoscopic donor nephrectomy and technical innovations to make it cost effective. , 2000, Transplantation proceedings.

[9]  F. Port,et al.  Effect of waiting time on renal transplant outcome. , 2000, Kidney international.

[10]  L. Kavoussi,et al.  Laparoscopic Donor Nephrectomy , 2000, Seminars in laparoscopic surgery.

[11]  R E Latchaw,et al.  Recommendations for the establishment of primary stroke centers , 2000 .

[12]  J. Wolf,et al.  Prospective, case matched comparison of hand assisted laparoscopic and open surgical live donor nephrectomy. , 2000, The Journal of urology.

[13]  P. Kuo,et al.  Laparoscopic donor nephrectomy with a 23-hour stay: a new standard for transplantation surgery. , 2000, Annals of surgery.

[14]  A Milstein,et al.  Selective referral to high-volume hospitals: estimating potentially avoidable deaths. , 2000, JAMA.

[15]  Christine Cottingham,et al.  Interhospital transport of the extremely ill patient: The mobile intensive care unit , 2000, Critical care medicine.

[16]  J. Squifflet,et al.  Laparoscopic and open live donor nephrectomy: a cost/benefit study , 2000, Transplant international : official journal of the European Society for Organ Transplantation.

[17]  S. Johnston,et al.  Which unruptured cerebral aneurysms should be treated? , 1999, Neurology.

[18]  S. Johnston,et al.  Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals , 1999, Neurology.

[19]  P. Kuo,et al.  Laparoscopic donor nephrectomy increases the supply of living donor kidneys: a center-specific microeconomic analysis. , 1999, Transplantation.

[20]  R. Falcone,et al.  Helicopter transport of patients to tertiary care centers after cardiac arrest. , 1999, The American journal of emergency medicine.

[21]  P. Kuo,et al.  Laparoscopic living donor nephrectomy and multiple renal arteries. , 1998, American journal of surgery.

[22]  Benjamin Littenberg,et al.  Effectiveness of helicopter versus ground ambulance services for interfacility transport. , 1998, The Journal of trauma.

[23]  D. Strauss,et al.  Long-term survival of children and adolescents after traumatic brain injury. , 1998, Archives of physical medicine and rehabilitation.

[24]  A. Monaco,et al.  Two hundred one consecutive living-donor nephrectomies. , 1998, Archives of surgery.

[25]  L. Kavoussi,et al.  Laparoscopic live donor nephrectomy removes disincentives to live donation. , 1997, Transplantation proceedings.

[26]  W. Rosenberger,et al.  Comparison of open and laparoscopic live donor nephrectomy. , 1997, Annals of surgery.

[27]  K. Fujita,et al.  Retroperitoneoscopy assisted live donor nephrectomy: the initial 2 cases. , 1997, The Journal of urology.

[28]  L. Dunn,et al.  Secondary insults during the interhospital transfer of head-injured patients: an audit of transfers in the Mersey Region. , 1997, Injury.

[29]  A S Detsky,et al.  Primer on Medical Decision Analysis: Part 5—Working with Markov Processes , 1997, Medical decision making : an international journal of the Society for Medical Decision Making.

[30]  Z. Yuan,et al.  Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences. , 1997, Journal of neurosurgery.

[31]  M. Weinstein,et al.  Theoretical Foundations of Cost-Effectiveness Analysis , 1996 .

[32]  B. Gage,et al.  The Effect of Stroke and Stroke Prophylaxis With Aspirin or Warfarin on Quality of Life , 1996 .

[33]  A. Laupacis,et al.  A study of the quality of life and cost-utility of renal transplantation. , 1996, Kidney international.

[34]  D K Owens,et al.  Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation. , 1995, JAMA.

[35]  R. Brook,et al.  Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes. , 1995, JAMA.

[36]  R. Wuerz,et al.  Adverse Events during Interfacility Transfers by Ground Advanced Life Support Services , 1994, Prehospital and Disaster Medicine.

[37]  J R Beck,et al.  Markov Models in Medical Decision Making , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[38]  D. Churchill,et al.  THE QUALITY OF LIFE IN RENAL TRANSPLANTATION—A PROSPECTIVE STUDY , 1992, Transplantation.

[39]  S. Ridley,et al.  The effects of secondary transport on critically ill patients , 1989, Anaesthesia.

[40]  R. Kanter,et al.  Adverse events during interhospital transport: physiologic deterioration associated with pretransport severity of illness. , 1989, Pediatrics.

[41]  A. Novick,et al.  Flank donor nephrectomy: efficacy in the donor and recipient. , 1989, The Journal of urology.

[42]  S. Wilson.  Methods for the economic evaluation of health care programmes , 1987 .

[43]  H. Luft,et al.  The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? , 1987, Health services research.

[44]  A. Hackel,et al.  Transport of critically ill adults , 1986, Critical care medicine.

[45]  J. Fink,et al.  Laparoscopic live donor nephrectomy: the University of Maryland 3-year experience. , 2000, The Journal of urology.

[46]  D. Petitti,et al.  Critical care transport: outcome evaluation after interfacility transfer and hospitalization. , 1999, Annals of emergency medicine.

[47]  F. Giubilei,et al.  Long-term prognosis after a minor stroke: 10-year mortality and major stroke recurrence rates in a hospital-based cohort. , 1998, Stroke.

[48]  S. Mayer,et al.  Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. , 1996, Stroke.

[49]  Milton C. Weinstein,et al.  Valuing health care: From cost–effectiveness ratios to resource allocation: where to draw the line? , 1995 .