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Factors Affecting Hospital Cost After Liver Transplantation: Implications of Broader Sharing
Audrey Ertel*, Koffi Wima, Daniel E. Abbott, Shimul a. Shah, Richard S. Hoehn
General Surgery, University of Cincinnati, Cincinnati, OH
Objectives: Due to the critical shortage of donor livers in the United States, policy changes under consideration are aimed at increasing broader sharing of organs to reduce current wait-list mortality. One potential detriment of this approach would be higher MELD recipients at the time of orthotopic liver transplantation (OLT), leading to increased resource utilization and financial pressures on transplant programs.
Methods: By linking hospital financial records and our prospective clinical database, we analyzed 256 patients who underwent OLT from 2007 to 2013 at our transplant center. Patients who died in index transplant, re-transplants, and patients with missing data were excluded. Factors including age, race, gender, BMI at transplant, and MELD score were analyzed. Cost was defined as sum of direct and indirect hospital costs. Endpoints included cost of OLT admission and one-year total cost (costs for transplant admission and all readmissions within 1 year of OLT).
Results: Patients in the highest MELD quartile (28-40) had significantly higher transplant admission cost and one-year total cost (median \,581 and \,732) than those patients in the lowest MELD quartile (6-13) (median \,823 and \,679; p = <0.001; p = 0.009). This trend was seen across all four MELD score quartiles. Transplant admission length of stay (LOS) was also increased with MELD scores (lowest quartile: 7 days, highest quartile: 12 days; p=0.0012). Of the variables analyzed, MELD score proved to be the only statistically significant predictor of increased cost. There was no difference in transplant admission cost or 1-year total cost based on age, race, gender, or BMI.
Conclusion: Analysis of our hospital's data/financial records indicates that increasing MELD score is an important indicator of increased hospital costs after OLT, despite a fixed bundled payment. Hospital reimbursement may/will suffer under policy changes that increase the MELD of OLT candidates.
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