Heart Transplant Allocation Change Results in Increased Cost and Initial Decrease in Transplant Volume: The Florida Experience

Abstract

PurposeIn October 2018, the United Network for Organ Sharing (UNOS) implemented a change in orthotopic heart transplant allocation policy in an effort to better stratify the most urgent transplant candidates.MethodsWe aimed to identify the impact of this policy change in Florida using an Interrupted Time Series Analysis (ITSA) technique. The 2016-2019 Florida Agency for Health Care Administration Inpatient data was queried for patients undergoing orthotopic heart transplantation. Patients <18 years of age were excluded in analysis. Patient demographics, before and after implementation of the UNOS allocation policy change, were evaluated using chi square and t-test; p≤0.05 was considered significant. These included Charlson Comorbidity Index, various post-operative outcomes, and hospital length of stay (LOS). Separate ITSA models were implemented to compare unit change in the number of transplants and total gross hospital charges.ResultsA total of 759 heart transplants were performed in Florida from 2016-2019. Data were compared before and after the allocation change: between 2016Q1-2018Q3 and 2018Q4-2019Q4. We found no difference with respect to post-operative outcomes, anesthesia or ICU charges, or total LOS (40.7 vs 39.3 days; p>0.05) before and after the policy change; however, total hospital charges differed significantly ($932,930 vs $1,167,889; p<0.05). ITSA modeling revealed a significant increase in total transplant charges after policy change, with an initial decrease in transplant volume (-17.8 transplants; 95% CI, -8.9 to -26.8, p<0.001) (Figure 1).ConclusionThe change in UNOS heart transplant allocation policy resulted in a decrease in transplant volume along with a significant increase in total transplant charges but without an associated increase in hospital LOS or ICU charges. These increased charges may be due to an increase in transport/travel charges. In October 2018, the United Network for Organ Sharing (UNOS) implemented a change in orthotopic heart transplant allocation policy in an effort to better stratify the most urgent transplant candidates. We aimed to identify the impact of this policy change in Florida using an Interrupted Time Series Analysis (ITSA) technique. The 2016-2019 Florida Agency for Health Care Administration Inpatient data was queried for patients undergoing orthotopic heart transplantation. Patients <18 years of age were excluded in analysis. Patient demographics, before and after implementation of the UNOS allocation policy change, were evaluated using chi square and t-test; p≤0.05 was considered significant. These included Charlson Comorbidity Index, various post-operative outcomes, and hospital length of stay (LOS). Separate ITSA models were implemented to compare unit change in the number of transplants and total gross hospital charges. A total of 759 heart transplants were performed in Florida from 2016-2019. Data were compared before and after the allocation change: between 2016Q1-2018Q3 and 2018Q4-2019Q4. We found no difference with respect to post-operative outcomes, anesthesia or ICU charges, or total LOS (40.7 vs 39.3 days; p>0.05) before and after the policy change; however, total hospital charges differed significantly ($932,930 vs $1,167,889; p<0.05). ITSA modeling revealed a significant increase in total transplant charges after policy change, with an initial decrease in transplant volume (-17.8 transplants; 95% CI, -8.9 to -26.8, p<0.001) (Figure 1). The change in UNOS heart transplant allocation policy resulted in a decrease in transplant volume along with a significant increase in total transplant charges but without an associated increase in hospital LOS or ICU charges. These increased charges may be due to an increase in transport/travel charges.