OBJECTIVES: Therapeutic plasma exchange (TPE) is a procedure that removes pathogenic substances of high molecular weight such as antibodies, endotoxins, circulating immune complexes and cholesterol-containing lipoproteins from plasma. During TPE procedure, patient blood is drawn into the medical device that separate and remove plasma from cellular component. The removed plasma goes into the waste bag and replaced with plasma substitute fluid, which are then returned to the patient. According to 2016 guidelines of the American Society of Apheresis (ASFA), TPE is recommended first line treatment in various disease category; neurology, transplantation, intensive care settings, renal and hematology. Plasma exchange can be performed using centrifugal or membrane filtration method. This study assessed the cost associated with these techniques from payer perspective.

METHODS: TPE utilization and cost data were collected from nephrology and hematology department, The First Affiliated Hospital, Xiamen, China. 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.

RESULTS: A total of 92 TPE procedures were performed annually with over half of the patients (67.3%) used centrifugation method. The estimated cost per procedure for centrifugal and membrane TPE were USD 557 (CNY 3,854), rounded to nearest integer, and USD 1321 (CNY 9138), respectively. Payer is expected to save USD 764 (CNY 5284) for every TPE performed using centrifugal compare to membrane method.

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