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The economic impact of laparoscopic living-donor nephrectomy on kidney transplantation

Background. End-stage renal disease accounts for $17.9 billion annually in direct medical costs in the United States. This study assessed the flow of expenditures from a Medicare perspective for laparoscopic donor nephrectomy compared with living and cadaveric transplantation and continued dialysis. Methods. This study involved a nonrandomized, retrospective investigation of patients with end-stage renal disease and charges using institutional and physician/supplier charges from the United States Renal Data System. The subjects were classified as laparoscopic living-donor transplant, living-donor transplant, cadaveric transplant, or dialysis patients. The first treatment date was set as the index date, and monthly charges were plotted from 12 months before and up to 48 months after the index date. Results. There were 230,769 dialysis patients and 44,063 transplant patients (181 laparoscopic living-donor, 11,466 living-donor, and 32,416 cadaveric). Monthly institutional charges were similar in the year preceding the index date, but they were higher for transplantation in the month after the index date and lower in subsequent periods. Two-year post-index cumulative charges were as follows: Monthly institutional charges were similar for the living-donor ($191,374) and laparoscopic living-donor ($192,053) transplant patients, followed by the cadaveric transplant ($229,449) and dialysis ($250,348) patients, whereas physician/supplier charges were highest for the laparoscopic living-donor transplant ($104,583) patients, followed by the dialysis ($73,730), cadaveric transplant ($70,369), and living-donor transplant ($65,897) patients. The break-even points for the living-donor, laparoscopic living-donor, and cadaveric transplant patients compared with the dialysis patients were 10, 14, and 18 months, respectively. Conclusions. The laparoscopic procedure may be a beneficial alternative to the conventional open donor nephrectomy procedure and cadaveric transplantation, and it provides considerable benefits compared with dialysis.