A new study by UC San Francisco health policy researchers has found that age, severity of illness of patients, and the types of services patients receive have a major impact on hospital resource use for liver transplantation. These findings, according to the researchers, suggest that guidelines to standardize resource use may lower costs of liver transplants.
"This is the first study to address the relationship between resources used for this procedure and specific patient characteristics and clinical practices," said Jonathan Showstack, PhD, MPH, UCSF professor of medicine and health policy.
"Findings from this study may be used to improve the cost-effectiveness of liver transplantation and to inform organ allocation policies." The study published in this week's (April 21) Journal of American Medical Association examined hospital costs for liver transplants at the University of California San Francisco Medical Center, the Mayo Clinic, and the University of Nebraska. The study provides estimates of the costs associated with different levels of illness severity and other patient characteristics. Findings of the study highlight the clinical, economic, and ethical dilemmas in liver transplantation.
Study findings showed that higher donor age and age of recipient were both associated with higher costs of liver transplantation. Researchers found transplant recipients with donors 60 years or older were 28 percent more costly than donors under 60 years. Recipients who were also 60 years or older were 17 percent more costly to treat.
Patients with alcoholic liver disease were 26 percent more costly than patients without the disease. Patients classified as severely ill at the time of transplant also were 40 percent more costly to treat. "Our data suggest that the recent policy change that places severely ill patients high on the waiting list could lead to a substantial increase in resources used for liver transplantation in the United States," said Showstack. The researchers also found that although the three transplant centers studied treated similar patients and had similar outcomes, the centers had different clinical practices in such services as use of diagnostic tests, therapies, and nursing care. These differences, said the researchers resulted in large variations in hospital costs.
Given these high variations between transplant centers, methods to reduce the differences in practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care, said the researchers. Liver transplantation, according to researchers, is among the most costly medical services, yet few studies have addressed the relationship between resources used for the procedure and specific patient characteristics and clinical practices. The few studies that have examined costs of liver transplants used non-standardized hospital charges as a measure of resource use.
In this study, the researchers used a standardized resource use database in which all hospital services for liver transplants at the three centers were matched to a single price list. The researchers then tested the association of patient and clinical characteristics to resource use.
The researchers collected clinical and utilization data from 711 patients, 16 years or older, who received single-organ liver transplants between January 1991 and July 1994.
Mean length of stay (from day of transplantation to day of discharge) was 21.2 days and mean total resource use in (1995) dollars was $203,434. Room and care averaged 26 percent of total resource use, diagnostics, which included imaging, laboratory and pathology was an average of 17 percent of total resource use. Treatment such as operating room charges, medication, blood products and respiratory services averaged 33 percent.
Co-authors of the study are Patricia Katz, PhD, UCSF professor of medicine and health policy; John Lake, MD, former medical director of the UCSF Liver Transplant program, professor of medicine and surgery and director of the Liver Transplant Program at the University of Minnesota, Minneapolis; Robert Brown, Jr., MD, MPH assistant professor of medicine, pediatrics, and epidemiology, Columbia University College of Physicians and Surgeons; R. Adams Dudley, MD, MBA, UCSF professor of medicine and health policy; Steven Belle, PhD, assistant professor of epidemiology, University of Pittsburgh, Russell Wiesner, MD, professor of medicine, Mayo Clinic; Rowen Zetterman, MD, professor of medicine, University of Nebraska; and James Everhart, MD, MPH, chief, Epidemiology and Clinical Trials Branch,National Institute of Diabetes and Digestive and Kidney Diseases.
Journal
JAMA