Therapeutic Plasma Exchange: A Cost-Consequence Analysis Using Data From a Tertiary Care Hospital

Therapeutic plasma exchange (TPE) is a costly procedure and is commonly used as an effective treatment modality for a range of life-threatening neurological, hematological, and autoimmune disorders. In this study, both the clinical and economic aspects of TPE were evaluated in hospitalized patients at a tertiary teaching hospital. This cost-consequence analysis was conducted for 246 patients who received TPE during the hospitalization course. Data were extracted from patients' medical records and the hospital information system. Indications were categorized according to the ASFA 2023 guideline, which classifies indications from Category I to IV based on the strength of supporting evidence. Direct medical costs were estimated using a micro-costing approach. A binary outcome measure was applied. A favorable outcome was defined as partial or complete recovery, and an unfavorable outcome as no recovery or death. Neurologic disorders and TTP were the predominant indications, with most procedures undertaken for ASFA Category I-II indications. The median direct cost was 987 million IRR (USD 3464) per patient and 197 million IRR (USD 690) per session, with albumin and apheresis sets together contributing more than three-quarters of total expenditure. Costs were greater among patients who achieved a favorable clinical outcome. Adverse events were infrequent. TPE is an effective and costly intervention. Optimizing resource utilization may reduce the economic burden, particularly in resource-limited settings. These findings can inform future planning, cost-effectiveness and cost-minimization analyses, managerial decision-making, and optimization of clinical protocols in line with the ASFA 2023 guideline.