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Utilizing the index for mortality prediction after cardiac transplantation risk score to predict hospital resource
Eric I Jeng1, David J Hall1, Juan Vilaro2
1Division of Thoracic and Cardiovascular Surgery, College of Medicine, University of Florida, Gainesville, Florida.
Insights
Higher risk scores in cardiac transplant patients correlate with increased hospital costs and resource use. The IMPACT score effectively predicts higher expenses for index admissions after heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Economics
Background:
- The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) risk score is validated for predicting mortality post-orthotopic heart transplantation (OHTx).
- The potential of the IMPACT score to predict hospital costs and resource consumption remains unexplored.
Purpose of the Study:
- To investigate the association between preoperative IMPACT risk scores and index hospitalization costs following OHTx.
- To determine if higher IMPACT risk scores correlate with increased hospital resource utilization.
Main Methods:
- Retrospective review of adult OHTx patients from 2000-2014.
- Stratification of patients into quartiles based on IMPACT risk scores.
- Analysis of index hospitalization costs and length of stay, with statistical comparisons between quartiles.
Main Results:
- A significant positive correlation was found between IMPACT risk scores and index hospitalization costs.
- Patients in the highest IMPACT risk quartile (Q4) incurred significantly higher costs compared to the lowest quartile (Q1).
- Median length of stay was also significantly longer for patients in Q4 versus Q1.
Conclusions:
- This study establishes a novel positive correlation between recipient risk, as measured by the IMPACT score, and hospital costs in adult cardiac transplantation.
- Higher IMPACT risk scores are associated with increased resource consumption and higher index admission costs post-OHTx.
Objective:
The index for mortality prediction after cardiac transplantation (IMPACT) risk score incorporates 12 preoperative recipient-specific variables, and has been validated as an accurate predictor of short- and long-term mortality after orthotopic heart transplantation (OHTx). We believe it can also be used to predict hospital costs, and we hypothesize that higher preoperative IMPACT risk scores are associated with increased hospital resource consumption.
Methods:
All OHTx patients ≥18 years of age at our institution were reviewed from 1 January 2000 to 31 December 2014. Total index hospitalization costs post-transplant were extracted and presented in 2014 consumer price index inflation-adjusted US dollars. Patients were stratified into quartiles (Q) according to IMPACT risk scores. Logarithmic transformation normalized cost data, and linear regression assessed for correlation. A comparison of cost between Q of IMPACT risk score was performed using rank-sum and Kruskal-Wallis tests. Survival was estimated using the Kaplan-Meier method.
Results:
Three hundred fifty-six (n = 356) OHTx were performed during the study period. The median IMPACT score for the cohort was five (interquartile range [IQR] 3-6). Eight (2.2%) patients died within 30-days and 1-year Kaplan-Meier survival was 88.3%. The median length of stay (LOS) was 16 (IQR 14-24) days. The median hospital cost for index admission was $222 200 (IQR:$169 200-$313 700). Median LOS was longer in Q4 vs Q1 (18 days vs 15 days, P = .01) and index hospital costs in Q4 were significantly higher compared to Q1 patients ($280 400 vs $205 000, P < .01). There was a significant positive correlation between IMPACT risk score and cost (regression coefficient .04, P < .01).
Conclusion:
This is the first study in adult cardiac transplantation to identify a positive correlation between hospital cost and recipient risk using the IMPACT risk score. Cost and resource consumption for the index admission after OHTx were significantly higher in the highest IMPACT risk Q compared with patients in the lowest Q.
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