*Purpose: We performed the cost-benefit analyses comparing Total Laparoscopic Retroperitoneoscopic donor nephrectomy (TLTLRPDN) versus Hand-assisted laparoscopic donor nephrectomy (HALDN) operations performed at our centre since 2011. Recently published cost figures of Robotic assisted donor nephrectomy (RADN) were used to compare our results.

*Methods: We used a micro-costing approach to estimate the cost from the hospital perspective for N= 173 minimal access donor nephrectomies ( N= 137 – TLRPDN; 35 – HALDN). Cost estimates took into account, sterilization costs for multiple-use equipment, costs for purchasing single-use equipment, staff, hospital stay and intraoperative medications and post-op analgesia. Quality-Adjusted Life Year (QALY) was assessed at 1-year post-operatively and then annually.

*Results: The donor characteristics were similar in both groups: Median age 52.7 ( 26-78) years – TLRPDN/ 54 ( 25-74) years – HALDN, Median BMI 26.5±4 TLRPDN versus 27.2±5 HALDN, Mean PCA time 1.6 days TLRPDN versus 2.4 days HALDN, Mean Hospital stay 3.5 ± 1.2 days TLRPDN versus 4.1± 1.6 days. (p=NS) The average costs for a single non complicated TLRPDN was (total $12,203)- Theatre ( Instruments, & Staff) $6,444; Ward-Stay $4968 and Other Costs (tests, drugs & PCA) $791. The average costs for a single non complicated HALDN was ( total $13,390)- Theatre (Instruments & Staff) $7,251; Ward-Stay $4,967 and Other Costs (tests, drugs and PCA) $1,172. In comparison, the published data quotes average RADN theatre alone costs at $8913 . The average Quality Adjusted Life Year (QALY) at 1 and 3 years were 0.84/2.54 for TLRPDN and 0.79/ 2.32 for HALDN. The QALY gained with TLRPDN was 0.22, with cost per QALY gained at 3 years was $2,551.

*Conclusions: TLRPDN provides cost-benefit compared to HALDN . More costing data needs to be published with regards to RADN.

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