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Published on: November 7, 2020
Incremental costs of post-liver transplantation complications
John B Ammori1, Shawn J Pelletier, Raymond Lynch
1Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0331, USA.
Insights
Liver transplant complications significantly increase costs for both medical centers and payers. However, the payor ultimately shoulders the financial burden of these post-transplant complications.
Area of Science:
- Hepatology
- Transplantation Surgery
- Health Economics
Background:
- Post-liver transplantation complications are frequent and costly.
- The financial impact of these complications and responsibility for payment remains unclear.
Purpose of the Study:
- To determine the incremental costs of adult liver transplantation complications.
- To identify who bears the financial responsibility for these complications: the medical center or the payor.
Main Methods:
- Review of medical and financial records for 214 adult liver transplant recipients (2002-2005).
- Analysis of donor, recipient, and financial data, including total costs, reimbursements, and profits.
- Use of multiple linear regression to assess the incremental costs of complications, controlling for recipient and donor factors.
Main Results:
- Complications significantly increased hospital costs and reimbursements.
- Model for End-Stage Liver Disease (MELD) score and pneumonia were independently associated with higher costs and reimbursements.
- Peritonitis was linked to a negative profit margin for the medical center.
- Commercial insurance did not alter total costs but reduced reimbursement and profit.
Conclusions:
- The incremental costs of liver transplant complications are substantial for both medical centers and payors.
- Medical center profits are not significantly impacted by these complications.
- The payor bears the primary financial burden for post-liver transplantation complications.
Background:
Complications after liver transplantation are common and expensive. The incremental costs of adult posttransplantation liver transplantation complications and who pays for these complications (center or payor) is unknown.
Study Design:
We reviewed the medical and financial records (first 90 postoperative days) of all adult liver transplant recipients at our center between July 1, 2002, and October 30, 2005 (N = 214). The association of donor, recipient, and financial data points (total costs, reimbursements, and profits) was assessed using standard univariable analyses. The incremental costs of complications were determined with multiple linear regression models to control for the costs inherent to donor and recipient characteristics.
Results:
Univariate analyses demonstrated that both total hospital costs and reimbursements were substantially increased in patients with several different complications. Multiple linear regression analysis, controlling for recipient (age, gender, race, and laboratory Model for End-Stage Liver Disease [MELD]) and donor factors (donor risk index), noted that increased hospital costs and hospital reimbursements were independently associated with laboratory MELD (incremental costs of $3,368 and $2,787, respectively, per MELD point) and pneumonia ($83,718 and $68,214, respectively). A negative profit margin for the medical center was independently associated with peritonitis ($21,760). Commercial insurance was associated with no changes in total costs when compared with public insurer, but it was associated with decreased reimbursement and profit.
Conclusions:
The incremental costs of complications in liver transplantation are high for both the medical center and payor, but medical center profits are not affected substantially. The payor bears the financial burden for post-liver transplantation complications.
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