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Laparoscopic versus open donor nephrectomy

  • K.T. Pace
  • S.J. Dyer
  • V. Phan
  • R.J. Stewart
  • R.J.D.A. Honey
  • E.C. Poulin
  • C.M. Schlachta
  • J. Mamazza

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.

Keywords

Organ Donor Societal Perspective Graft Function Donor Rate Dominant Strategy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag New York Inc. 2003

Authors and Affiliations

  • K.T. Pace
    • 1
  • S.J. Dyer
    • 1
  • V. Phan
    • 2
  • R.J. Stewart
    • 1
  • R.J.D.A. Honey
    • 1
  • E.C. Poulin
    • 2
  • C.M. Schlachta
    • 3
  • J. Mamazza
    • 3
  1. 1.Division of Urology, St. Michael's Hospital, University of Toronto, Ontario, CanadaCA
  2. 2.Division of Nephrology, Hospital for Sick Children, University of Toronto, Ontario, CanadaCA
  3. 3.Division of Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, Ontario, CanadaCA

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