Trends in expenditures for Medicare liver transplant recipients.

Liver transplantation, a resource-intensive medical procedure, is under particular scrutiny in the current era of cost containment. There have been significant changes in treatment protocols over the past decade; however, information is limited on how these changes have affected the economics of liver transplantation. This study examines a time series from 1993 to 1999 in Medicare expenditures for liver transplantation. We estimated total first- and second-year expenditures, as well as expenditures 90 days pretransplantation. These expenditures included inpatient, outpatient, physician, home health, and hospice care; immunosuppression expenditures were not estimated. Average first-year expenditures (in year 2000 dollars) for liver transplantation, excluding immunosuppressives, decreased from 201,677 dollars in 1993 to 143,363 dollars in 1998. Inpatient costs accounted for the majority of total expenditures, decreasing from 179,306 dollars in 1993 to 120,445 dollars in 1998. Total days of hospitalization decreased from 56.7 days in 1993 to 42.2 days in 1998. The majority of hospitalization occurred during the first 90 days posttransplantation, but decreased from 44.4 days in 1993 to 29.4 days in 1999. Substantial cost reductions over this period were a result of reduced hospitalization and occurred while survival rates gradually improved.