Abstract
HIPEC using custom-made machines (CMM) remains unaffordable for many patients in low-income countries. We describe the assembly and use homemade HIPEC machine (HMM) as a cost-effective alternative. We evaluated the cost of setting up the HMM, maintenance, expenses per procedure as well as technical aspects including target temperature and flow rate, safety aspects, technical failures and the technical support required. The comparison with CMM was based on the manufacturer information and published reports and not on personal experience. Form 2011 to 2017, we performed HIPEC (Coliseum technique) in 81 patients using HMM. HMM was a cardiopulmonary bypass machine available in our institution, with an additional water bath. Flow rate was 2 L/min and target temperature between 41 and 43 °C could be achieved in all cases. There were no technical failures and there was no safety issue recorded. Routine maintenance was provided yearly by an in-house technician. Chemotherapy costs (between 20 and 500 USD) were independent from the devices used. Cost of consumables was 450 USD/procedure, as compared to 1800 to 3500 USD/procedure for commercially available products. Investment cost for CMM is between 70,000 and 1,35,000 USD. The HMM is a cost-effective option allowing access to HIPEC to patients in low-resource countries without loss of efficacy or additional safety concerns. The initial cost and cost per procedure were substantially less for HMM while the maintenance of both systems was similar in terms of complexity and cost. The CMM are more user-friendly and require less technical support.
Highlights
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) prolong survival significantly in selected patients with peritoneal metastases (PM) compared with systemic chemotherapy alone [1]
The role of HIPEC is established for pseudomyxoma peritonei (PMP) and malignant peritoneal mesothelioma and is under investigation for other indications [2,3,4]
We performed a comparison of the cost of setting up the machine, maintenance, expenses per procedure as well as technical aspects like achieving and maintaining target temperature and flow rate, safety aspects, technical failures and the technical support required to run the homemade machine with the custom-made machines (CMM) commercially available
Summary
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) prolong survival significantly in selected patients with peritoneal metastases (PM) compared with systemic chemotherapy alone [1]. There are several variables involved in HIPEC – choice of drugs, the carrier solution used and its volume, the duration of the procedure, the level of hyperthermia, the flow rate, and the technique –open or closed [10]. Some variables like the technique of HIPEC, the degree of hyperthermia, volume of perfusate and the flow rate depend on the apparatus used that comprises of a roller pump and a heating device. Methods: We evaluated the cost of setting up the HMM, maintenance, expenses per procedure as well as technical aspects including target temperature and flow rate, safety aspects, technical failures and the technical support required. Conclusions: The HMM is a cost-effective option allowing access to HIPEC to patients in low-resource countries without loss of efficacy or additional safety concerns. The initial cost and cost per procedure were substantially less for HMM while the maintenance of both systems was Keywords: HIPEC machine, HIPEC technology, homemade HIPEC machine, low-cost HIPEC machine
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