Bishara A Nassir1, Carl E Dean, Suying Li, Nicholas Salkowski, Craig A Solid, Mark A Schnitzler, Jon J Snyder, S Joseph Kim, Bertram L Kasiske, Mark Linzer, Ajay K Israni. 1. 1 Department of Medicine, Hennepin County Medical Center, Minneapolis, MN. 2 Department of Medicine, University of Minnesota, Minneapolis, MN. 3 Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN. 4 Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN. 5 Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO. 6 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. 7 Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Bending the cost curve in medical expenses is a high national priority. The relationship between cost and kidney allograft failure has not been fully investigated in the United States. METHODS: Using Medicare claims from the United States Renal Data System, we determined costs for all adults with Medicare coverage who underwent kidney transplant January 1, 2007, to June 30, 2009. We compared relative cost (observed/expected payment) for year 1 after transplantation for all transplant centers, adjusting for recipient, donor, and transplant characteristics, region, and local wage index. Using program-specific reports from the Scientific Registry of Transplant Recipients, we correlated relative cost with observed/expected allograft failure between centers, excluding small centers. RESULTS: Among 19,603 transplants at 166 centers, mean observed cost per patient per center was $65,366 (interquartile range, $55,094-$71,624). Mean relative cost was 0.99 (± 0.20); mean observed/expected allograft failure was 1.03 (± 0.46). Overall, there was no correlation between relative cost and observed/expected allograft failure (r = 0.096, P = 0.22). Comparing centers with higher than expected costs and allograft failure rates (lower performing) and centers with lower than expected costs and failure rates (higher-performing) showed differences in donor and recipient characteristics. As these characteristics were accounted for in the adjusted cost and allograft failure models, they are unlikely to explain the differences between higher- and lower-performing centers. CONCLUSIONS: Further investigations are needed to determine specific cost-effective practices of higher- and lower-performing centers to reduce costs and incidence of allograft failure.
BACKGROUND: Bending the cost curve in medical expenses is a high national priority. The relationship between cost and kidney allograft failure has not been fully investigated in the United States. METHODS: Using Medicare claims from the United States Renal Data System, we determined costs for all adults with Medicare coverage who underwent kidney transplant January 1, 2007, to June 30, 2009. We compared relative cost (observed/expected payment) for year 1 after transplantation for all transplant centers, adjusting for recipient, donor, and transplant characteristics, region, and local wage index. Using program-specific reports from the Scientific Registry of Transplant Recipients, we correlated relative cost with observed/expected allograft failure between centers, excluding small centers. RESULTS: Among 19,603 transplants at 166 centers, mean observed cost per patient per center was $65,366 (interquartile range, $55,094-$71,624). Mean relative cost was 0.99 (± 0.20); mean observed/expected allograft failure was 1.03 (± 0.46). Overall, there was no correlation between relative cost and observed/expected allograft failure (r = 0.096, P = 0.22). Comparing centers with higher than expected costs and allograft failure rates (lower performing) and centers with lower than expected costs and failure rates (higher-performing) showed differences in donor and recipient characteristics. As these characteristics were accounted for in the adjusted cost and allograft failure models, they are unlikely to explain the differences between higher- and lower-performing centers. CONCLUSIONS: Further investigations are needed to determine specific cost-effective practices of higher- and lower-performing centers to reduce costs and incidence of allograft failure.
Authors: D A Axelrod; M A Schnitzler; H Xiao; A S Naik; D L Segev; V R Dharnidharka; D C Brennan; K L Lentine Journal: Am J Transplant Date: 2016-10-04 Impact factor: 8.086
Authors: Andrew Wang; Juan Carlos Caicedo; Gwen McNatt; Michael Abecassis; Elisa J Gordon Journal: Transplantation Date: 2021-03-01 Impact factor: 5.385
Authors: Akhil Sharma; Dana R Jorgensen; Rajil B Mehta; Puneet Sood; Chethan M Puttarajappa; Christine M Wu; Amit D Tevar; Michele Molinari; Adriana Zeevi; Sundaram Hariharan Journal: Transpl Int Date: 2022-03-17 Impact factor: 3.782