Higher MELD score increases the overall cost on the waiting list for liver transplantation: a micro-costing analysis based study

Abstract

-Background -The pretransplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. Objective -The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. Methods -A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months followup, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. $ 5,703.22 ± 9,318.68). Conclusion -Total costs on the waiting list for liver transplantation increased according to the patient's severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems.

Costs Associated With Early Vascular and Biliary Complications in Liver-Transplanted Patients in a Hospital in Antioquia, Colombia 2019: A Case Series

“…For instance, costs are higher in patients with a MELD score of 25 to 45 than in those with a score ,25, with extended hospital stay, the use of intensive care units, and dialysis being the main costincreasing factors. Turri et al [17][18][19] assessed the total cost incurred by a patient on a waiting list for liver transplant, observing that the cost increased as the severity of the patient's disease increased. Post-transplant surgical complications negatively affect the costs, which may double, along with the hospital stay, which may prolong by even 3 times.…”

“…These patients represented 7641 additional hospital stay days, of which 3046 belonged to the intensive care unit. 20 Organ transplant costs refer to more than just the mere organ, because pretransplant care, 17 post-transplant costs, and the requirement of immunosuppressant drugs are also involved, which increase the burden of healthcare costs. 21 Transplant programs consume considerable resources from the health system, with large variations existing in the transplant costs across countries, and even across cities within the same country 22,23 ; nevertheless, these variations can be offset by improving patients' state of health and quality-adjusted life-years.…”

Impact of Meld Sodium on Liver Transplantation Waiting List

“…The adoption of MELD-Na, prioritizing and transplanting the most severe patients earlier, also has an important financial impact. Several studies have shown that increasing the severity of liver disease predisposes to a high number of hospitalizations and high-cost procedures before transplantation 18 , 20 .…”

“…Liver transplantation was first performed in the early 1960s by Thomaz Starzl in the United States of America. In a few decades it has become the procedure of choice for treatment of patients with end-stage liver cirrhosis 18 . In Brazil, the first transplant was carried out in 1968 at the Hospital das Clínicas, Medical School, University of São Paulo 7 .…”

Clinical impact of the Model for End Liver Disease (MELD) score on the presence of microvascular invasion and on the postoperative outcome in patients undergoing liver transplantation

“…Studies report a steady increase in the prevalence and incidence of NAFLD-related hepatocellular carcinoma. Soon there will likely be more cases of HCC related to NASH than to chronic hepatitis C. This will be possible because the treatment for the C virus is effective and can achieve viral eradication in almost all patients, while NASH is increasingly prevalent [14][15][16] .…”