Laparoscopic Donor Nephrectomy: Is It Cost Effective? Perspective From Health Economists

Abstract

A s with all health services, practices associated with kidney transplantation ought to be cost-effective, providing value for money as well as clinical efficacy. No health service has enough resources to provide every clinically effective intervention, and therefore whenever we introduce a new service it must be unintentionally displacing another effective practice. If the interventions provided have a low health gain relative to the money spent, then the health gain we will achieve will be less than the health gain we would have achieved by implementing the displaced activity; overall, patients will be worse off. The implication is that for new (and existing) procedures, we need to measure rigorously resource costs as well as health benefits. In this issue of Transplantation, Kok and colleagues conducted such an analysis alongside a randomized controlled trial of laparoscopic donor nephrectomy (LDN) versus mini-incision open donor nephrectomy (ODN) (1).Kidney transplantation both extends life and improves quality of life. To compare the value for money of different interventions requires a measure of health that incorporates both, such as the quality-adjusted life-year (QALY), where 1 QALY represents a health gain equivalent to extending life by 1 year at full quality of life (or by 2 years at 50% quality of life, etc.). Kok and colleagues recorded an increase of 0.03 QALYs per patient