Dageforde Leigh Anne, Moore Deonna R, Landman Matthew P, Feurer Irene D, Pinson C Wright, Poulose Benjamin, Penson David F, Moore Derek E
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
J Surg Res. 2012 Aug;176(2):e89-94. doi: 10.1016/j.jss.2011.12.013. Epub 2012 Mar 10.
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.
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.
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.
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.
活体供肾移植是终末期肾病的首选治疗方法。在1995年腹腔镜供肾切除术（LDN）出现之前，开放供肾切除术（ODN）一直是标准术式。此后不久又增加了手辅助腹腔镜供肾切除术（HALDN）。腹腔镜技术虽然会增加手术室时间和设备成本，但这些技术能加快患者恢复正常活动。本研究的目的是评估这些技术的成本。
建立了一个决策分析模型，以模拟接受ODN、LDN和HALDN的供者的结局。从机构视角（IP）和社会视角（SP）模拟结局。通过对文献的系统回顾确定基线值和范围。进行敏感性分析以检验模型的稳健性。
从IP来看，ODN是成本最低的策略，成本为11,000美元，而HALDN的成本为15,200美元，LDN的成本为15,800美元。从SP来看，HALDN是成本最低的策略，成本为27,800美元，而LDN的成本为29,000美元，ODN的成本为41,000美元。在敏感性分析中，只有当HALDN策略中恢复工作的天数超过58天时，ODN才成为主导策略。随着LDN的开放转换率接近零，LDN和HALDN几乎相当。
HALDN是成本最低的供肾切除术策略，尤其是从SP角度来看。该模型中成本的主要决定因素是转换为开放手术以及恢复工作的天数。
