Impact of Recipient MELD Score on Resource Utilization

Abstract

The model for end stage liver disease (MELD) system prioritizes deceased donor organs to the sickest patients who historically require higher healthcare expenditures. Limited information exists regarding the association of recipient MELD score with resource use. Adult recipients of a primary liver allograft (n = 222) performed at a single center in the first 27 months of the MELD system were analyzed. Costs were obtained for each recipient for the 12 defined categories of resource utilization from the time of transplant until discharge. True (calculated) MELD scores were used. Inpatient transplant costs were significantly associated with recipient MELD score (r = 0.20; p = 0.002). Overall 1-year patient survival was 85.0% and was not associated with MELD score (p = 0.57, log rank test). Recipient MELD score was significantly associated with costs for pharmacy, laboratories, radiology, dialysis and physical therapy. Multivariate linear regression revealed that MELD score was most strongly associated with cost compared to other demographic and clinical factors. Recipient MELD score is correlated with transplant costs without significantly impacting survival.

Use of a severity indicator as a predictor of the use of hepatic transplantation resources

“…Another important study in Texas, also with use of multivariate analysis, on the correlations observed regarding the use of resources in liver receptors, showed that the indicator has predictive ability of its use in medicine/pharmacy, clinical laboratory, radiology, dialysis and physiotherapy, which this study partially corroborates (21) . In the studied unit and period, it should be noted that, however, the records were not evaluated on the use of drugs and physiotherapy procedures.…”

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

“…By transplanting patients most likely to die without a transplant, the MELD system has been very successful in achieving the goal of lowering wait-list mortality. Unfortunately, this rising severity of illness is also likely to increase the overall cost of LT, particularly in regions in which increased competition and demand for organs results in a higher MELD score at transplantation (1,5,16).…”

“…The cost of liver transplantation (LT) continues to rise as a result of current allocation systems for deceased donor organs that require that the 'sickest' be transplanted first, while reimbursement is static or declining leading to significant financial risk for the nation's transplant centers (1)(2)(3)(4)(5). Furthermore, despite a reduction in wait-list mortality following the implementation of model for end-stage liver disease (MELD), patients continue to die awaiting an organ leading to national efforts to expand access to transplantation through the utilization of 'marginal donors' (6).…”

Process of Care Events in Transplantation: Effects on the Cost of Hospitalization

“…Transplantation, nonetheless, entails sophisticated surgical interventions, coordination of interdisciplinary teams in pre-and postoperative care and complex medication regimens, all processes shown to be highly vulnerable to even small deviations from the planned processes of care (5)(6)(7)(8). Understanding the nature of potentially preventable medical events, to avert their possible negative impact on outcomes and resource utilization, is critical, especially in transplantation that focuses on the care of the very ill and utilizes precious donated organs and high-cost procedures (9)(10)(11)(12).…”