OBJECTIVES: Therapeutic plasma exchange (TPE) is a procedure that removes large volume of plasma from a patient. Through the bulk removal and replacement of plasma, pathogenic substances that cause underlying disease such as antibodies, endotoxins, circulating immune complexes and cholesterol-containing lipoproteins were removed. It is a common treatment modality in management of various renal, hematological and neurological diseases. Plasma exchange can be performed using centrifugal (c) or membrane (m) filtration method. This study assessed the cost associated with these techniques from public payer perspective.

METHODS: TPE utilization and cost data were collected from nephrology department, Deenanath Mangeshkar Hospital, Pune, India. 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 with increase number of TPE procedures on centrifugal technique.

RESULTS: A total of 166 TPE procedures were performed annually; membrane (90%) and centrifugal (10%). In the sensitivity analysis, converting 90% mTPE to cTPE, cost per procedure for centrifugal and mTPE was estimated at USD 261 (INR 18,117), rounded to nearest integer, and USD 371 (INR 25,763), respectively. Plasma exchange with membrane technique cost the payer additional USD 110 (INR 7,646) for each TPE procedure. Additional savings of USD 29 (INR 2000) was expected for each cTPE procedure with peripheral access. The projected annual cost savings with predominant use of centrifugal technique was USD 33,210 (INR 2,305,392).

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