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Out-of-pocket expenses associated with pediatric heart transplantation
Whitney W Kaslow1, Nancy A Jaworski1, Courtney Crawford1
1Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
Insights
Pediatric heart transplant families face significant out-of-pocket costs, with commercial insurance leading to higher expenses. Investigating financial burden mitigation strategies is crucial for these families.
Area of Science:
- Pediatric Cardiology
- Health Economics
- Transplant Medicine
Background:
- Pediatric heart transplantation utilizes significant resources.
- The financial burden on families undergoing pediatric heart transplantation is not well understood.
- Understanding out-of-pocket expenses is critical for family support.
Purpose of the Study:
- To examine the out-of-pocket expenses associated with pediatric heart transplantation.
- To identify patient and demographic factors influencing these costs.
- To assess family satisfaction with insurance coverage.
Main Methods:
- An anonymous REDCap survey was distributed to caregivers of pediatric heart transplant recipients.
- Data collection occurred via social media, national organizations, and clinic encounters from May to August 2022.
- 146 caregivers completed the survey, providing data on expenses and insurance.
Main Results:
- Median monthly out-of-pocket expense was $250; 13.7% reported >$1000 monthly.
- Families with commercial insurance had higher expenses ($350) than government-sponsored insurance ($100).
- Cardiac catheterizations and unplanned admissions were the highest expense-incurring events.
Conclusions:
- Families of pediatric heart transplant recipients incur substantial out-of-pocket expenses.
- Insurance type significantly impacts financial burden, with commercial insurance being costlier.
- Strategies to alleviate the financial strain on these families require further investigation.
Introduction:
Heart transplantation in children is associated with high resource utilization. However, the financial burden on families and the association with patient and demographic factors remains unclear. This study aims to examine out-of-pocket expenses associated with pediatric heart transplantation.
Methods:
An anonymous REDCap survey was distributed to caregivers of children who have undergone heart transplantation using social media, national organizations, and during clinic encounters from May through August 2022.
Results:
There were a total of 146 respondents. The median monthly out-of-pocket expense was $250 (IQR $75-$500) and 20 respondents (13.7%) reported monthly expenses of >$1000. Families with commercial insurance reported significantly higher out-of-pocket expenses compared to those with government-sponsored insurance (median $350 vs. $100, p < .001). Families with government-sponsored insurance were most happy with their insurance coverage, followed by commercial insurance and then coverage through the Affordable Care Act (p < .001 for all pairwise comparisons). There was no statistically significant difference in overall transplant-related out-of-pocket expenses based on total household income (p = .222). Monthly out-of-pocket expense was not associated with the number of medications, type of immunosuppressants, or post-transplant complications including rejection, PTLD, or CAV (p = NS for all). Cardiac catheterizations and unplanned admissions were reported as the events that incurred the highest out-of-pocket expense.
Conclusion:
Families of children who have undergone heart transplantation can incur significant out-of-pocket expenses and strategies to mitigate this financial burden should be investigated.
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