Predictors of micro-costing components in liver transplantation

Abstract

OBJECTIVES:Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models.METHODS:We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases.RESULTS:A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8.CONCLUSION:By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards.

Hepatic and portal vein transection by vascular stapler in open living donor hepatectomy – A retrospective cohort study

“…Indeed, the use of the vascular stapler in the surgical setting remains costly. Taking health economics into account, we are aware that its utilization adds an additional cost driver in LDLT, particularly with regard to transplant programs in countries undergoing cost containment [ 17 ]. However in our view, the benefits derived from using the same vascular stapler device for PV and HV justify the higher costs and moreover, cost-saving strategies at the expense of the donor should be discouraged in a highly delicate procedure such as LDLT.…”

An exploratory study of the experiences of deceased‐donor liver transplant recipients and their need for psychotherapeutic support

“…In 2017/18, 933 adults in the UK underwent liver transplantation (NHS Blood & Transplant, 2019). Each transplant is associated with extensive financial cost incurred from surgery, employment of the multidisciplinary team and in medications (Haddad, Ducatti, Mendes, Andraus, & D'Albuquerque, 2017). However, the patients' psychological and emotional health are neglected with no known dedicated psychotherapy service available for adults within liver transplant centres in the UK.…”

Relação entre custos, Balance of Risk Score e desfechos em pacientes submetidos a transplante de fígado entre 2010 e 2018 pelo programa de transplantes Einstein

“…O TxF é um dos procedimentos mais caros em cirurgia abdominal, consumindo uma grande quantidade de recursos da saúde. (38) No entanto, na era pré-MELD, estudos mostravam uma queda do custo relacionado ao TxF, devido a melhorias das técnicas empregadas e redução do tempo de internação hospitalar. (39) Após a introdução da escala de MELD, em função do conceito sickest first, este custo aumentou consideravelmente.…”

“…Por um lado, em uma análise sumária, pacientes mais graves possuem maior risco de complicações pós-operatórias e podem apresentar maior tempo de internação hospitalar, fatores conhecidos como preditores de aumento de custo. (38) Entretanto, por outro lado, em função de um fenômeno conhecido como risco competitivo (Competing Risk), (43) esses mesmos fatores podem também determinar maior mortalidade precoce que, por sua vez, determinaria um movimento inverso, no sentido de redução de impacto em custos. Apesar de parecerem complexas neste cenário específico, análises de custoefetividade poderiam endereçar tal questão de forma mais apropriada.…”

“…Interessante também analisar que, estudo prospectivo observacional brasileiro já citado neste texto, demonstrou que MELD acima de 30 era o fator mais importante relacionado à alto custo do TxF. (38) Sendo o BARS uma escala que considera não apenas a gravidade da doença do receptor, mas outras características relacionadas ao doador e ao procedimento, MELDs altos podem encaixar-se em faixas de BARS intermediárias (abaixo de 18 pontos) e podem explicar os achados do estudo em questão.…”