The Economic Impact of the Utilization of Liver Allografts with High Donor Risk Index

Axelrod, David A.; Salvalaggio, Paolo R.; Swindle, Jason; Abécassis, Michaël

doi:10.1111/j.1600-6143.2006.01724.x

Cited by 95 publications

(103 citation statements)

References 27 publications

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“…We have previously explored the impact of the DRI on LOS and estimated cost at a registry level (9). In that analysis, it was principally the highest DRI livers, which drove costs.…”

Section: Discussionmentioning

confidence: 99%

“…Prior assessment of the relationship between MELD and cost has been limited by a lack of nationally representative cost data (1,9,(11)(12)(13)(14). Using a novel database that links clinical data from the Organ Procurement and Transplantation Network (OPTN) with cost accounting data from a national sample of liver transplant centers, we developed a detailed analysis of the relationship between severity of illness and cost.…”

Section: Economics Of Liver Allocationmentioning

confidence: 99%

“…These changes may increase the cost of transplantation in these regions. However, there will likely be an offsetting reduction in the use of marginal organs in what are currently the most under-supplied regions, and corresponding savings by reducing the need to use high DRI organs in the highest MELD recipients (9,10). Third, we could not directly account for changes in the proportion of livers that would be used for liver-kidney transplants.…”

Section: Economics Of Liver Allocationmentioning

confidence: 99%

“…Given the geographic variation in access to liver transplant, areas with a relative donor shortage are forced to transplant patients with higher MELD scores using more marginal organs. Consequently, these transplant centers face disproportionate financial and clinical risk (9,10). Broader organ-sharing proposals have been considered by the United Network for Organ Sharing (UNOS) Liver and Intestine Transplant Committee.…”

Section: Introductionmentioning

confidence: 99%

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The Economic Implications of Broader Sharing of Liver Allografts

Axelrod

Gheorghian

Schnitzler

et al. 2011

American Journal of Transplantation

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Liver transplantation has evolved over the past four decades into the most effective method to treat endstage liver failure and one of the most expensive medical technologies available. Accurate understanding of the financial implication of recipient severity of illness is crucial to assessing the economic impact of allocation policies. A novel database of linked clinical data from the Organ Procurement and Transplantation Network with cost accounting data from the University HealthSystem Consortium was used to analyze liver transplant costs for 15 813 liver transplants. This data was then utilized to consider the economic impact of alternative allocation systems designed to increase sharing of liver allografts using simulation results. Transplant costs were strongly associated with recipient severity of illness as assessed by the MELD score (p < 0.0001); however, this relationship was not linear. Simulation analysis of the reallocation of livers from low MELD patients to high MELD using a two-tiered regional sharing approach (MELD 15/25) resulted in 88 fewer deaths annually at estimated cost of $17 056 per quality-adjusted life-year saved. The results suggest that broader sharing of liver allografts offers a cost-effective strategy to reduce the mortality from end stage liver disease.

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“…We have previously explored the impact of the DRI on LOS and estimated cost at a registry level (9). In that analysis, it was principally the highest DRI livers, which drove costs.…”

Section: Discussionmentioning

confidence: 99%

Section: Economics Of Liver Allocationmentioning

confidence: 99%

Section: Economics Of Liver Allocationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Economic Implications of Broader Sharing of Liver Allografts

Axelrod

Gheorghian

Schnitzler

et al. 2011

American Journal of Transplantation

Self Cite

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“…The policies, management styles, organizational structure and financial aspects of each center were evaluated. The inclusion of financial practices and efficiency among 'best practices' is noteworthy, amid concerns about the costs associated with increasing use of ECD and DCD organs (2,3). These practices were then vetted through an expert panel in the spring of 2007 to establish a set of 'common drivers of change'.…”

Section: Efforts and Accomplishments Of The Collaborative In The Pastmentioning

confidence: 99%

Organ Donation and Utilization in the United States, 1997–2006

Sung

Galloway

Tuttle‐Newhall

et al. 2008

American Journal of Transplantation

110

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Deceased organ donation has increased rapidly since 2002, coinciding with implementation of the Organ Donation Breakthrough Collaborative. The increase in donors has resulted in a corresponding increase in the numbers of kidney, liver, lung and intestinal transplants. While transplants for most organs have increased, discard and nonrecovery rates have not improved or have increased, resulting in a decrease in organs recovered per donor (ORPD) and organs transplanted per donor (OTPD). Thus, the expansion of the consent and recovery of incremental donors has frequently outpaced utilization. Meaningful increases in multicultural donation have been achieved, but donations continue to be lower than actual rates of transplantation and waiting list registrations for these groups. To counteract the decline in living donation, mechanisms such as paired donation and enhanced incentives to organ donation are being developed. Current efforts of the collaborative have focused on differentiating ORPD and OTPD targets by donor type (standard and expanded criteria donors and donors after cardiac death), utilization of the OPTN regional structure and enlisting centers to increase transplants to match increasing organ availability.

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