Abstract
OBJECTIVES: Individuals who volunteer to undergo hand-assisted laparoscopic donor nephrectomy (HALDN) to help those needing renal transplants, face postoperative infection complications (POICs) risks for no corresponding clinical benefit. Prophylactic antibiotics often control POIC risk; however, there is no clear consensus on their use in HALDN. Considering the incidence of POICs, National Health Service (NHS) resource constraints, and antimicrobial stewardship priorities, a cost-effectiveness analysis (CEA) was conducted to evaluate the economic impact of prophylactic antibiotic use in HALDN. METHODS: A CEA was conducted using data from the UK multicenter, double-blinded, randomized controlled POWAR (Prophylaxis of Wound Infections-antibiotics in Renal Donation) trial. The primary outcome was the cost per POIC avoided within 30 days post-HALDN. Effectiveness was defined as the absence of POICs. The incremental cost-effectiveness ratio (ICER) was calculated in British pounds. Four sensitivity analyses examined variability in drug costs, length of stay, POIC severity, and cost thresholds. RESULTS: The ICER for antibiotic prophylaxis compared with no prophylaxis was -£4,709.71, indicating that prophylaxis was cost-saving. Sensitivity analyses under all 4 scenarios confirmed the robustness of this cost-saving finding under varying assumptions. CONCLUSION: Antibiotic prophylaxis in HALDN is a cost-saving intervention. These findings support the need to review UK guidelines for antibiotic use in living donor renal transplant surgery, specifically regarding prophylactic measures for donors. Further clarification on whether HALDN should be classified as a 'clean' or 'clean-contaminated' procedure may enhance consistency in national practice and inform evidence-based antibiotic stewardship and policy aligned with NHS goals for safe and sustainable surgical care.