PMD20 CENTRIFUGAL VERSUS MEMBRANE THERAPEUTIC PLASMA EXCHANGE: SINGLE CENTER COST BENEFIT ANALYSIS IN THAILAND

Abstract

Therapeutic plasma exchange (TPE) is a common treatment modality in management of various renal, hematological and neurological diseases in which large volume of plasma is removed and replaced with replacement fluid. Through TPE, pathologic substances that cause the underlying disease such as inflammatory mediators; autoantibodies, complement components and cytokines are eliminated and substantially improve patient quality of life. TPE can be performed using two categories of devices; membrane or centrifugal. We aimed to analyze the cost associated with these techniques from payer perspective. We estimated cost of membrane and centrifugal TPE based on 250 procedures performed annually in Prasat Neurological Institute, Thailand. Micro-costing approach was applied according to local clinical practice, and other probabilities were derived from published literature. Cost component includes device acquisition, maintenance, consumables, procedure time, plasma replacement fluids, clotting events and labor. The model assumed similar clinical outcome in these techniques. Overall estimated TPE cost per procedure using membrane and centrifugal techniques were USD 380 (rounded to nearest integer) and USD 241, respectively. We projected an annual savings of USD 34,759 (36%) for centrifugal TPE application in 250 procedures. The difference in the total time (set-up and procedure) for both techniques (mTPE, 150 minutes vs cTPE, 96 minutes) may be minimal for each procedure, however that translate to 6 weeks staff time saved per year for each centrifugal TPE procedure. We demonstrated that centrifugal TPE had a better cost benefit ratio than membrane TPE.