The Costs of Human Uterus Transplantation

A Study Based on the Nine Cases of the Initial Swedish Live Donor Trial

Thomas Davidson; Jana Ekberg; Lars Sandman; Mats Brännström

Disclosures

Hum Reprod. 2021;36(2):358-366. 

In This Article

Results

Total Costs

By summing all costs, the total costs of a UTx procedure is calculated to €74 564 from a societal perspective (Table II). Data on specification of sub-sets of costs can be found in the sections below. The cost of sick leave at €19 164 was the highest component. If a health care perspective of the analysis was used (not including productivity loss) the total cost decreases to €55 400. Using the lowest and highest cost among the cases for all parameters provides an interval between €50 960 and €99 658, from a societal perspective. This calculation also includes the absence of any re-hospitalization costs for 8/9 donors and 4/9 recipients (see below).

Costs of Preoperative Investigations

The total costs for the preparations for the UTx procedure covering meetings, tests, and IVF is calculated at €11 739, out of which the recipient-related costs constituted 75% (Table III).

Costs of Surgery and Hospital Stay

The costs of surgeries, presented for each donor and recipient separately, are presented in Table IV. The anaesthesia cost (mean) for the recipient and the donor combined was €7207. There was a variation in anaesthesia cost, with the three first procedures having higher costs than the six last procedures. The reason for this is a long duration of anaesthesia, waiting for insertion of the organ, concerning the three initial patients, as explained in Materials and Methods. The mean surgery cost was €12 779 and the mean cost for postoperative hospitalizations was €13 246. Thus, the mean hospital cost for the initial procedure (including anaesthesia, surgery and post-surgery hospitalization) was €33 232 for a live-donor procedure, with considerable costs (58%) for donor. The costs for non-anaesthesia medication during hospitalization is not included in these costs but rather specified below.

Costs of Medication

Immunosuppression-related drugs for recipients from just before UTx and then continuously during the observation period had a total mean cost of €4521 per transplantation (Table V). Non-immunosuppression-related pharmaceuticals in hospital and during follow-up time had a total mean cost of €629 for the recipient (piperacillin/tacobactam iv, pantoprazol oral, dalterapin sc, paracetamol oral, oxycodone oral) and €671 for the donor (piperacillin/tacobactam iv, pantoprazol iv and oral, dalterapin sc, paracetamol oral, oxycodone oral, sodiumpikosulphate oral), giving a total mean cost of €1300.

Cost of Tests After Operation, Re-hospitalization and Sick-leave

Tests after the operation include pathology tests (cervix biopsy), vaginal culture and blood test. Pathology tests and vaginal culture were taken at five times, with a total cost of €2455 for each patient with a graft in situ (recipient No. 1–8) and no cost for recipient No. 9, with early graft loss. Blood tests, including tacrolimus concentration, at a cost each of €90, were taken twice weekly during the initial 2 weeks after hospitalization and then tapered out, with a total of 10 times (total cost for each patient €903) for patient No. 1–8 during the study time. Thus, the total costs after surgery for each patient with graft in situ was €3358, and the mean (including patient No. 9) was €2985.

Data of the costs for re-hospitalization and sick leave of all the recipients and the donors are presented in Table VI. Four patients were re-hospitalized 1–2 days for iv treatments with corticosteroids to reverse rejections. In recipient-donor pair No. 2 re-hospitalization was for infection (recipient) and ureteric-vaginal fistula (donor). The mean costs for re-hospitalization was €1623. The mean costs of sick leave was €19 164.

processing....