Comparison of Open Live Donor Nephrectomy, Laparoscopic Live Donor Nephrectomy, and Hand-Assisted Live Donor Nephrectomy: A Cost-effectiveness Analysis

INTRODUCTION: Live donor kidney transplantation is the treatment of choice for end-stage renal failure. Open Donor Nephrectomy (ODN) was the standard until the introduction of Laparoscopic Donor Nephrectomy (LDN) in 1995. Hand-Assisted Laparoscopic Donor Nephrectomy (HALDN)was added shortly thereafter. While decreasing post-operative analgesic requirements and speeding return to normal activity, the laparoscopic techniques are associated with longer operative times and a minor increase in peri-operative complications. The aim of this study is to evaluate the cost-effectiveness of the different techniques.

METHODS: A decision analytic model was created to simulate outcomes for donors undergoing ODN, LDN, and HALDN. Baseline values and ranges were determined from the SRTR database and a literature review. Sensitivity analyses were conducted to test model strength and parameter variability.

RESULTS: Donors undergoing LDN and HALDN accrued less cost and had a superior quality of life when all factors were considered in this model. HALDN costs are lower $13,000 vs LDN $15,000 and ODN $17,000. HALDN was the dominant scenario in all models.

CONCLUSIONS: By requiring less post-operative analgisia, returning to normal activity faster, and having a more favorable peri-operative complication rate; the HALDNwas the more cost-effective procedure for live donor nephrectomy.

Session: Podium Presentation

Program Number: S006

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