Justin Godown1, Cary Thurm2, Matt Hall2, Jonathan H Soslow1, Brian Feingold3, Bret A Mettler4, Andrew H Smith5, David W Bearl1, Debra A Dodd1. 1. Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN. 2. Children's Hospital Association, Lenexa, KS. 3. Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA. 4. Pediatric Cardiothoracic Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN. 5. Pediatric Critical Care, Monroe Carell Jr. Children's Hospital, Nashville, TN.
Abstract
BACKGROUND: Despite significant changes in the past decade for children undergoing heart transplantation, including the evolution of mechanical circulatory support and increasing patient complexity, costs and resource utilization have not been reassessed. We sought to use a novel linkage of clinical-registry and administrative data to examine changes in hospitalization costs over time in this population. METHODS: We identified all pediatric heart transplant recipients in a unique linked Pediatric Health Information System/Scientific Registry of Transplant Recipients data set (2002-2016). Hospital costs were estimated from charges using cost-to-charge ratios, inflated to 2016 dollars. Severity-adjusted costs were calculated using generalized linear mixed-effects models. Costs were compared across 3 eras (era 1, 2002-2006; era 2, 2007-2011; and era 3, 2012-2016). RESULTS: A total of 2896 pediatric heart transplant recipients were included: era 1, 649 (22.4%); era 2, 1028 (35.5%); and era 3, 1219 (42.1%). Extracorporeal membrane oxygenation support at transplant decreased over time, concurrent with an increase in ventricular assist device-supported patients. Between era 1 and era 2, there was an increase in pretransplant hospitalization costs (US $343 692 vs US $435 554; P < 0.001). However, between era 2 and era 3, there was a decline in total (US $906 454 vs US $767 221; P < 0.001), pretransplant (US $435 554 vs US $353 364; P < 0.001), and posttransplant (US $586 133 vs US $508 719; P = 0.002) hospitalization costs. CONCLUSIONS: Concurrent with the increase in utilization of ventricular assist device support, there has been an increase in pretransplant costs associated with pediatric heart transplantation. However, in the most recent era, costs have declined. These findings suggest the evolution of more cost-effective management strategies, which may be related to shifts in the approach to pediatric mechanical circulatory support.
BACKGROUND: Despite significant changes in the past decade for children undergoing heart transplantation, including the evolution of mechanical circulatory support and increasing patient complexity, costs and resource utilization have not been reassessed. We sought to use a novel linkage of clinical-registry and administrative data to examine changes in hospitalization costs over time in this population. METHODS: We identified all pediatric heart transplant recipients in a unique linked Pediatric Health Information System/Scientific Registry of Transplant Recipients data set (2002-2016). Hospital costs were estimated from charges using cost-to-charge ratios, inflated to 2016 dollars. Severity-adjusted costs were calculated using generalized linear mixed-effects models. Costs were compared across 3 eras (era 1, 2002-2006; era 2, 2007-2011; and era 3, 2012-2016). RESULTS: A total of 2896 pediatric heart transplant recipients were included: era 1, 649 (22.4%); era 2, 1028 (35.5%); and era 3, 1219 (42.1%). Extracorporeal membrane oxygenation support at transplant decreased over time, concurrent with an increase in ventricular assist device-supported patients. Between era 1 and era 2, there was an increase in pretransplant hospitalization costs (US $343 692 vs US $435 554; P < 0.001). However, between era 2 and era 3, there was a decline in total (US $906 454 vs US $767 221; P < 0.001), pretransplant (US $435 554 vs US $353 364; P < 0.001), and posttransplant (US $586 133 vs US $508 719; P = 0.002) hospitalization costs. CONCLUSIONS: Concurrent with the increase in utilization of ventricular assist device support, there has been an increase in pretransplant costs associated with pediatric heart transplantation. However, in the most recent era, costs have declined. These findings suggest the evolution of more cost-effective management strategies, which may be related to shifts in the approach to pediatric mechanical circulatory support.
Authors: Aamir Jeewa; Cedric Manlhiot; Brian W McCrindle; Glen Van Arsdell; Tilman Humpl; Anne I Dipchand Journal: Artif Organs Date: 2010-12 Impact factor: 3.094
Authors: Joseph W Rossano; Anne I Dipchand; Leah B Edwards; Samuel Goldfarb; Anna Y Kucheryavaya; Bronwyn J Levvey Rn; Lars H Lund; Bruno Meiser; Roger D Yusen; Josef Stehlik Journal: J Heart Lung Transplant Date: 2016-08-21 Impact factor: 10.247
Authors: Lars H Lund; Leah B Edwards; Anne I Dipchand; Samuel Goldfarb; Anna Y Kucheryavaya; Bronwyn J Levvey; Bruno Meiser; Joseph W Rossano; Roger D Yusen; Josef Stehlik Journal: J Heart Lung Transplant Date: 2016-08-21 Impact factor: 10.247
Authors: Rebecca Smith-Bindman; Diana L Miglioretti; Eric Johnson; Choonsik Lee; Heather Spencer Feigelson; Michael Flynn; Robert T Greenlee; Randell L Kruger; Mark C Hornbrook; Douglas Roblin; Leif I Solberg; Nicholas Vanneman; Sheila Weinmann; Andrew E Williams Journal: JAMA Date: 2012-06-13 Impact factor: 56.272
Authors: Justin Godown; Matt Hall; Bryn Thompson; Cary Thurm; Kathy Jabs; Lynette A Gillis; Einar T Hafberg; Sophoclis Alexopoulos; Seth J Karp; Jonathan H Soslow Journal: Pediatr Transplant Date: 2019-02-21
Authors: David W Bearl; Debra A Dodd; Cary Thurm; Matt Hall; Jonathan H Soslow; Brian Feingold; Justin Godown Journal: Pediatr Cardiol Date: 2018-12-13 Impact factor: 1.655