Cost and Use Trends of Endomyocardial Biopsy in Heart Transplant Patients: A 4-Year Claims Data Analysis

This study evaluated patterns of utilization, complications, and costs of endomyocardial biopsies (EMB) in heart transplant patients.

The IBM Treatment Pathways tool was used to analyze claims data selected from IBM's MarketScan de-identified Health Insurance Portability and Accountability Act (HIPAA)-compliant dataset. Differences in EMB paid amounts and utilization patterns were assessed for commercial payers and Medicare (2016-2019). The type, frequency, and overall cost of complications of the EMB procedure in these patients were also evaluated.

A total of 8,170 records (6,385 commercial payers and 1,785 Medicare) of heart transplant patients with evidence of EMB procedures performed between 2016 and 2019 were identified in the database. In 2019, the median paid amount for an outpatient EMB in a heart transplant patient was US $7,918 (commercial) and US $2,980 (Medicare). Heart transplant patients received between 4.6 and 6.8 (median; Medicare, commercial) EMBs the first year after the transplant. Approximately 25% of EMB procedures were associated with complications. In 2019, the total median cost of EMB complications per patient was US $9,049.

Analysis showed that the paid amount for the EMB procedure increased by almost 25% from 2016 to 2019 for commercial payers. Given the high frequency of complications after the EMB procedure and the associated cost of the complications, it is estimated that the median paid amounts are closer to US $10,000 per patient per EMB. Given the number of EMBs provided, the associated risks, and the paid amount trends, non-invasive alternatives to EMB should be considered for the surveillance of heart transplant patients.