Increased Resource Utilization Post 2018 Heart Allocation Policy Change

The 2018 United Network of Organ Sharing (UNOS) heart allocation policy change has shifted the way patients are bridged to heart transplant. The true cost of the policy change has not been examined using a large national database. The Healthcare Cost and Utilization Project Database (HCUP) National Inpatient Sampling database (2015-2022) was used to identify adult heart transplant recipients before and after the policy change, examining resource utilization between the two policy periods. There was an increase in the use of temporary mechanical circulatory support devices in the current era, along with a longer mean length of stay and more discharges to non-acute facilities. Despite similar inpatient mortality rates, the median total inpatient charge increased significantly (Old Policy: $685,263 vs. New Policy: $959,756; p < 0.001). The length of stay has also increased in the current policy period, and more patients are discharged to rehabilitation facility or places other than home. The increase in charge is also reflected in the total cost to the hospital (Old Policy: $172,935 ($122,611-$ 271,196) vs. New Policy: $241,277 ($167,353-$ 363,415), p<0.001). These findings further highlight increased resource utilization in current heart transplantation practice in the United States, warranting further discussion of healthcare utilization and outcomes.