Xin Tao Ye1, Alice Parker2, Johann Brink3, Robert G Weintraub4, Igor E Konstantinov5. 1. Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia. 2. Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia. 3. Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia. 4. Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Australia. 5. Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: igor.konstantinov@rch.org.au.
Abstract
OBJECTIVES: Cost data for pediatric heart transplantation are scarce. We examined hospital cost of the national pediatric heart transplantation program in Australia and assessed factors associated with increased costs. METHODS: The hospital cost of all children who underwent heart transplantation at a national referral center between January 2003 and June 2015 and were followed more than 1 year was retrospectively analyzed. Lifetime follow-up costs were adjusted for quality of life and projected to life expectancy. All costs were reported in 2016 US dollars. RESULTS: Of 70 children who underwent heart transplantation in the study period, 61 were followed more than 1 year after transplantation (mean, 4.3 ± 2.5 years). Mean cost of primary heart transplantation was $278,480 (95% confidence interval, 219,282-337,679) and did not change over time. Pretransplant mechanical circulatory support was required in 36% (22/61) of children. On multivariable analysis, greater admission costs were associated with ventricular assist device and pretransplant length of stay. Mean annual follow-up cost after discharge was $55,823 (95% confidence interval, 47,631-64,015) in the first year and $12,119 (95% confidence interval, 8578-15,661) thereafter. Increased first-year follow-up costs were associated with endomyocardial biopsies and length of readmissions. Cost per quality-adjusted life-year gained varied from $29,161 to $44,481 on sensitivity analysis. Freedom from treated rejections was 65.5% at 1 year, 63.2% at 3 years, and 59.5% at 5 years. Endomyocardial biopsies contributed to 52% of first-year follow-up costs. CONCLUSIONS: Primary pediatric heart transplantation in Australia is cost-effective for long-term survivors, even for those supported by ventricular assist device. Surveillance endomyocardial biopsy was a major contributor to post-transplantation costs. Selective targeting of surveillance biopsies may be cost-saving. Crown
OBJECTIVES: Cost data for pediatric heart transplantation are scarce. We examined hospital cost of the national pediatric heart transplantation program in Australia and assessed factors associated with increased costs. METHODS: The hospital cost of all children who underwent heart transplantation at a national referral center between January 2003 and June 2015 and were followed more than 1 year was retrospectively analyzed. Lifetime follow-up costs were adjusted for quality of life and projected to life expectancy. All costs were reported in 2016 US dollars. RESULTS: Of 70 children who underwent heart transplantation in the study period, 61 were followed more than 1 year after transplantation (mean, 4.3 ± 2.5 years). Mean cost of primary heart transplantation was $278,480 (95% confidence interval, 219,282-337,679) and did not change over time. Pretransplant mechanical circulatory support was required in 36% (22/61) of children. On multivariable analysis, greater admission costs were associated with ventricular assist device and pretransplant length of stay. Mean annual follow-up cost after discharge was $55,823 (95% confidence interval, 47,631-64,015) in the first year and $12,119 (95% confidence interval, 8578-15,661) thereafter. Increased first-year follow-up costs were associated with endomyocardial biopsies and length of readmissions. Cost per quality-adjusted life-year gained varied from $29,161 to $44,481 on sensitivity analysis. Freedom from treated rejections was 65.5% at 1 year, 63.2% at 3 years, and 59.5% at 5 years. Endomyocardial biopsies contributed to 52% of first-year follow-up costs. CONCLUSIONS: Primary pediatric heart transplantation in Australia is cost-effective for long-term survivors, even for those supported by ventricular assist device. Surveillance endomyocardial biopsy was a major contributor to post-transplantation costs. Selective targeting of surveillance biopsies may be cost-saving. Crown
Authors: Raymond Vanholder; Beatriz Domínguez-Gil; Mirela Busic; Helena Cortez-Pinto; Jonathan C Craig; Kitty J Jager; Beatriz Mahillo; Vianda S Stel; Maria O Valentin; Carmine Zoccali; Gabriel C Oniscu Journal: Nat Rev Nephrol Date: 2021-05-05 Impact factor: 28.314