Journal article
Assessing Variation in the Costs of Care Among Patients Awaiting Liver Transplantation
American journal of transplantation, Vol.14(1), pp.70-78
01/01/2014
DOI: 10.1111/ajt.12494
PMID: 24165015
Abstract
Previous economic analyses of liver transplantation have focused on the cost of the transplant and subsequent care. Accurate characterization of the pretransplant costs, indexed to severity of illness, is needed to assess the economic burden of liver disease. A novel data set linking Medicare claims with transplant registry data for 15710 liver transplant recipients was used to determine average monthly waitlist spending (N=249434 waitlist months) using multivariable linear regression models to adjust for recipient characteristics including Model for End-Stage Liver Disease (MELD) score. Characteristics associated with higher spending included older age, female gender, hepatocellular carcinoma, diabetes, hypertension and increasing MELD score (p<0.05 for all). Spending increased exponentially with severity of illness: expected monthly spending at a MELD score of 30 was 10 times higher than at MELD of 20 ($22685 vs. $2030). Monthly spending within MELD strata also varied geographically. For candidates with a MELD score of 35, spending varied from $19548 (region 10) to $36099 (region 7). Regional variation in waitlist costs may reflect the impact of longer waiting times on greater pretransplant hospitalization rates among high MELD score patients. Reducing the number of high MELD waitlist patients through improved medical management and novel organ allocation systems could decrease total spending for end-stage liver care.
Using a national cohort-linking registry and medical claims data, the authors find that the cost of end-stage liver care among patients awaiting liver transplant increases dramatically with changes in severity of illness. See editorial by Abouljoud et al on page 9.
Details
- Title: Subtitle
- Assessing Variation in the Costs of Care Among Patients Awaiting Liver Transplantation
- Creators
- D. A. Axelrod - Dartmouth CollegeN. Dzebisashvili - Dartmouth CollegeK. Lentine - St Louis Univ, Ctr Outcomes Res, St Louis, MO 63103 USAD. L. Segev - Johns Hopkins UniversityR. Dickson - Dartmouth CollegeE. Tuttle-Newhall - Saint Louis UniversityR. Freeman - Dartmouth CollegeM. Schnitzler - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- American journal of transplantation, Vol.14(1), pp.70-78
- Publisher
- Wiley
- DOI
- 10.1111/ajt.12494
- PMID
- 24165015
- ISSN
- 1600-6135
- eISSN
- 1600-6143
- Number of pages
- 9
- Grant note
- Hitchcock Foundation K08DK073036 / NIDDK; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) RC1 1RC1DK086450-01 / American Recovery and Reinvestment Act grant from the National Institute of Diabetes Digestive and Kidney Diseases K08DK073036 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 01/01/2014
- Academic Unit
- Surgery
- Record Identifier
- 9984322933902771
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