Clinical Epidemiology Centre CIC 1433 Inserm, University Hospital of Nancy, Nancy, France.
Department of Urology, University Hospital of Nantes, Site Hôtel-Dieu, Nantes, France.
Nephrol Dial Transplant. 2020 Nov 1;35(11):2004-2012. doi: 10.1093/ndt/gfz143.
In Europe, transplantation centres use different nephrectomy techniques: open surgery, and standard, hand-assisted and robot-assisted laparoscopies. Few studies have analysed the disparity in costs and clinical outcomes between techniques. Since donors are healthy patients expecting minimum pain and fast recovery, this study aimed to compare the cost-effectiveness of four nephrectomy techniques focusing on early surgical outcomes, an essential in the donation act.
A micro-costing approach was used to estimate the cost of implementation from a hospital perspective. Estimates took into account sterilization costs for multiple-use equipment, costs for purchasing single-use equipment, staff and analgesics. The study recruited donors in 20 centres in France. Quality of life by EuroQol-5D was assessed preoperatively, and 4 and 90 days post-operatively. Two effectiveness indicators were built: quality-of-life recovery and post-operative pain days averted (PPDA). The study was registered at ClinicalTrials.gov NCT02830568, on 10 June 2010.
A total of 264 donors were included; they underwent open surgery (n = 65), and standard (n = 65), hand-assisted (n = 65) and robot-assisted laparoscopies (n = 69). Use of the nephrectomy techniques differed greatly in cost of implementation and immediate post-operative outcomes but not in clinical outcomes at 90 days. At 4 days, hand-assisted laparoscopy provided the lowest cost per quality-of-life recovery unit of effectiveness (%) and PPDA (days) (€2056/40.1%/2.3 days, respectively). Robot-assisted laparoscopy was associated with the best post-operative outcomes but with the highest cost (€3430/59.1%/2.6 days).
Hand-assisted, standard and robot-assisted laparoscopies are cost-effective techniques compared with open surgery. Hand-assisted surgery is the most cost-effective procedure. Robot-assisted surgery requires more healthcare resource use but enables the best clinical outcome.
在欧洲，移植中心采用不同的肾切除术技术：开放性手术，以及标准、手助式和机器人辅助腹腔镜手术。很少有研究分析技术之间的成本和临床结果差异。由于供体是健康的患者，期望最小的疼痛和快速康复，因此本研究旨在比较四种肾切除术技术的成本效益，重点关注早期手术结果，这是捐赠行为的关键。
采用微观成本法从医院角度估算实施成本。估计考虑了多次使用设备的消毒成本、单次使用设备、人员和镇痛药的购买成本。该研究在法国的 20 个中心招募了捐赠者。术前、术后 4 天和 90 天使用 EuroQol-5D 评估生活质量。构建了两个有效性指标：生活质量恢复和术后疼痛天数减少（PPDA）。该研究于 2010 年 6 月 10 日在 ClinicalTrials.gov 注册，编号为 NCT02830568。
共纳入 264 名捐赠者；他们接受了开放性手术（n=65）、标准（n=65）、手助式（n=65）和机器人辅助腹腔镜手术（n=69）。不同的肾切除术技术在实施成本和术后即刻结果方面存在很大差异，但在 90 天的临床结果方面没有差异。术后 4 天，手助式腹腔镜手术在每单位有效恢复生活质量的成本（%）和每单位有效恢复生活质量的成本（%）和术后疼痛天数减少（PPDA）方面的成本效益最低（分别为€2056/40.1%/2.3 天）。机器人辅助腹腔镜手术的术后结果最好，但成本最高（€3430/59.1%/2.6 天）。
与开放性手术相比，手助式、标准和机器人辅助腹腔镜手术是具有成本效益的技术。手助式手术是最具成本效益的手术。机器人辅助手术需要更多的医疗资源，但可以实现最佳的临床结果。
