PMD5 ECONOMIC BENEFIT OF CENTRIFUGAL VERSUS MEMBRANE THERAPEUTIC PLASMA EXCHANGE: A SINGLE INSTITUTION EXPERIENCE IN VIETNAM

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Therapeutic plasma exchange (TPE) is a procedure that removes pathogenic substance that cause the underlying disease such as harmful antibodies – immune complexes, cytokines or endotoxins from patient’s plasma. In a typical TPE procedure, 1 to 1.5 plasma volumes are removed and replaced with another fluid (human albumin or fresh frozen plasma). In the American Society for Apheresis guidelines, TPE is recommended first line therapy in management of various renal, hematological and neurological diseases. TPE can be performed using two categories of devices; membrane or centrifugal. This study assessed the cost associated with these techniques from public payer perspective. TPE utilization and cost data were collected from nephrology and hematology department, Hue Central Hospital, Vietnam. A cost benefit analysis model was created on Excel spreadsheet using micro-costing approach with the following cost component; device acquisition, maintenance, consumables, venous access, replacement fluids, labor. Data on procedure efficiency and clotting frequency were sought from published literatures. Clotting was defined as requiring filter replacement to continue procedure. The model assumed similar clinical outcome in these techniques. On average, 20 TPE procedures were performed annually with equal proportion of patients on both techniques. The estimated cost per procedure for centrifugal and membrane TPE were USD 856 (VND 19,984,545), rounded to nearest integer, and USD 1115 (VND 26,046,045), respectively. For every 10 procedures performed on centrifugal technique, payer is expected to save USD 2595 (VND 60,615,000). The economic evaluation between these two plasma exchange techniques showed centrifugal TPE had a better cost benefit than membrane TPE. For a hospital with similar characteristics, we expect positive economic impact with application of centrifugal TPE.