COMPONENTS OF CARE RESPONSIBLE FOR THE RISING COSTS INCURRED DURING THE PRE-TRANSPLANT PERIOD IN LIVER TRANSPLANT RECIPIENTS.

Abstract

92 Most information regarding the cost of care of the liver transplant recipient has focused upon the surgical procedure and the initial inpatient stay. Liver transplant programs have seen a progressive increase in the number of patients on waiting lists and an increase in length of time patients spend on lists due to the limited donor pool and increased access of patients to liver transplantation. At the University of Colorado the length of the waiting period for patients transplanted from 1/1/96-12/31/96 vs 1/1/97-6/30/97 vs 7/1/97-12/31/97 was 334 ± 187 vs 447 ± 190 vs 549 ± 234 days (excluding Status 1 listings). Purpose: In this study we examined number of hospitalizations, length of stay, and dollars expended in the year prior to transplantation for inpatient and outpatient care for patients transplanted at the University of Colorado Health Sciences Center. Two 6 month intervals were compared: Group I, transplanted between July and December of 1996 (N = 26), and Group II, transplanted between January and June of 1997 (N = 32). The two groups were gender- and age-matched, had similar severity of pretransplant illness, and equivalent survival and rates of retransplantation. Results: Results are expressed as means for Group I vs. Group II for all data. The average number of inpatient days per admitted patient was 10.5 vs 18.3d and the number of inpatient days per listed patient were 4.4 vs 8.0. Charges related to all pre-transplant inpatient care were$21,794 vs $36,987 per admitted patient, and $9,221 vs $16,182 per listed patient. The pretransplant charges of outpatient care decreased from $12,407 to $6,877 per patient. In this one year interval increases in the initial charges for liver transplantation (+$6,961) were only partially offset by reduction in charges of outpatient care (-$5,530). Conclusion: Increases in numbers of listed patients and length of time on the waiting list are associated with increases in days of hospitalization and charges of inpatient pretransplant care. Cost reduction measures focused solely on outpatient care will have only a short-term and limited impact on the total costs incurred by this expanding patient population.