OBJECTIVES: Therapeutic plasma exchange (TPE) is a procedure in which blood of the patient is passed through a medical device which separate plasma from other components of blood and the plasma is removed (ASFA 2016). It is a common treatment modality in management of various renal, hematological and neurological diseases. 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. This study assessed the cost associated with these techniques from payer perspective.

METHODS: TPE utilization and cost data were derived from Taipei Veterans General Hospital and Kaohsiung Medical University Hospital in Taiwan. 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. Sensitivity analysis was conducted comparing 100 TPE procedure on each technology.

RESULTS: Majority of TPE procedures were performed using membrane plasma filter due to absence of centrifugal consumables reimbursement code. Kaohsiung medical university hospital reported an average of 175 TPE procedures annually. From the sensitivity analysis, cost per procedure for centrifugal and membrane TPE was estimated at USD 198 (NT 6226), rounded to nearest integer, and USD 469 (NT 14,723), respectively. The projected annual cost savings from using centrifugal technique for plasma exchange was USD 27,044 (NT 850,132).

CONCLUSIONS: The economic evaluation between these two plasma exchange techniques showed centrifugal TPE had a better cost benefit than membrane TPE.