PUK7 THE EFFECT OF PRETRANSPLANT DIALYSIS MODALITIES ON POSTTRANSPLANT HEALTH SERVICES UTILIZATION AND MEDICARE REIMBURSEMENT: A PROPENSITY-MATCHED COMPARISON

Abstract

Medicare total expenditure on End-stage renal disease (ESRD) in 2015 was estimated to be $33.9 billion accounting for more than 7% of total Medicare expenditure. To our knowledge, no previous propensity score-matched study was conducted to compare the effect of pretransplant dialysis modalities no posttransplant healthcare services utilization and Medicare expenditure. To compare post-TX healthcare services utilization and Medicare reimbursement between pretransplant peritoneal and hemodialysis for adults with ESRD in the US. A propensity-matched retrospective study of renal recipients between January 2007 and December 2011, following ≥60 days of maintenance dialysis. All the data were obtained from the USRDS for the period 2006 to 2012. Adults who received either kidney or kidney/pancreas, with ≥6 months of pre-TX history were included. Patients with other organ transplants, two or more prior renal TXs, and missing data were excluded. Per-person-per-year (PPPY) and mean differences (M-Diff.) were calculated using multivariate regression analyses models. All the dollar values were adjusted to the 2018 inflation rate. A total of 19,612 renal recipients (9,806 pairs) were included. No difference in follow-up (HD=36.51 vs PD=36.08 months, p-value =0.0807). Nearly, 50% of recipients had 2-18 months of pretransplant dialysis. The 6-year total Medicare reimbursement for healthcare services use was $1.728 billion. Inpatient services accounted for 42%; physician fees, 30%; prescription medications, 12%; outpatient visits, 10%; and dialysis sessions, around 4%. Patients in the HD group had significantly higher PPPY number of and reimbursement on medications, inpatient events, and number of and reimbursement on home health visits. The PPPY total Medicare expenditure indicated that each HD recipient imposes a significantly higher total expenditure (M-Diff. =$1,134.50, p-value <.0001) compared to PD recipients. Our findings indicated that hemodialysis recipients’ utilization of and reimbursement on healthcare services impose a significant expense to Medicare compare to peritoneal dialysis patients.