Impact of the heart transplant allocation policy change on inpatient cost of index hospitalization

Abramov, Dmitry; Minhas, Abdul Mannan Khan; Fudim, Marat; Chung, Josh S.; Patel, Jay; Rabkin, David G.

doi:10.1111/ctr.14692

Cited by 10 publications

(9 citation statements)

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“…Mean total inflation‐adjusted heart transplantation costs (per transplant) have been reported to be $232,897 in 2016 and $235,030 in 2017 under the prior transplant allocation system 9 . In the updated transplant allocation system, these costs have risen to $255,243 in 2018 and $271,973 in 2019, as the allocation system prioritizes more acutely ill patients 9 .…”

Section: Discussionmentioning

confidence: 99%

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Health care resource utilization and clinical outcomes for adult heart transplant recipients with primary graft dysfunction

McCartney

Peskoe

Wright

et al. 2023

Clinical Transplantation

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IntroductionThe advent of new technologies to reduce primary graft dysfunction (PGD) and improve outcomes after heart transplantation are costly. Adoption of these technologies requires a better understanding of health care utilization, specifically the costs related to PGD.MethodsRecords were examined from all adult patients who underwent orthotopic heart transplantation (OHT) between July 1, 2013 and July 30, 2019 at a single institution. Total costs were categorized into variable, fixed, direct, and indirect costs. Patient costs from time of transplantation to hospital discharge were transformed with the z‐score transformation and modeled in a linear regression model, adjusted for potential confounders and in‐hospital mortality. The quintile of patient costs was modeled using a proportional odds model, adjusted for confounders and in‐hospital mortality.Results359 patients were analyzed, including 142 with PGD and 217 without PGD. PGD was associated with a .42 increase in z‐score of total patient costs (95% CI: .22‐.62; p < .0001). Additionally, any grade of PGD was associated with a 2.95 increase in odds for a higher cost of transplant (95% CI: 1.94‐4.46, p < .0001). These differences were substantially greater when PGD was categorized as severe. Similar results were obtained for fixed, variable, direct, and indirect costs.ConclusionsPGD after OHT impacts morbidity, mortality, and health care utilization. We found that PGD after OHT results in a significant increase in total patient costs. This increase was substantially higher if the PGD was severe.SummaryPrimary graft dysfunction after heart transplantation impacts morbidity, mortality, and health care utilization. PGD after OHT is costly and investments should be made to reduce the burden of PGD after OHT to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

“…As the new allocation system appropriately prioritizes more acutely ill patients, these costs are rising, with the increased use of temporary MCS and longer length of stay (LOS) as significant contributors to cost. 9 As such, PGD is both a clinical and a health care resource utilization problem.…”

Section: Unadjustedmentioning

confidence: 99%

Health care resource utilization and clinical outcomes for adult heart transplant recipients with primary graft dysfunction

McCartney

Peskoe

Wright

et al. 2023

Clinical Transplantation

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“…However, an unintended consequence of the increased availability of temporary MCS appears to be the strategy of utilizing a device as a listing mechanism rather than clinical management alone. This shift in behavior has raised concerns about rising transplant costs as well as whether all patients truly meet the criteria for higher urgency statuses and necessitates urgent attention [21].…”

Section: Balancing Medical Urgency and Waitlist Mortality In The Era ...mentioning

confidence: 99%

Challenges with the current United Network for Organ Sharing heart allocation system

Gong,

Hall

2023

Current Opinion in Organ Transplantation

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Purpose of review The revised United States heart organ allocation system was launched in October 2018. In this review, we summarize this United Network for Organ Sharing (UNOS) policy and describe intended and unintended consequences. Recent findings Although early studies published after the change suggested postheart transplant survival declined at 6 months and 1 year, recent publications with longer follow-up time have confirmed comparable posttransplant survival in adjusted models and several patient cohorts. Moreover, the new allocation decreased overall waitlist time from 112 to 39 days (P < 0.001). Mean ischemic time increased because of greater distances traveled to acquire donor hearts under broader sharing. Despite the intention to decrease exception requests by expanding the number of priority tiers to provide more granular risk stratification, ∼30% of patients remain waitlisted under exception status. Left-ventricular assist device (LVAD) implants are declining and the number of LVAD patients on the transplant list has decreased dramatically after the allocation system change. Summary As the next allocation system is developed, it is imperative to curtail the use of temporary mechanical support as a strategy solely for listing purposes, identify attributes that more clearly stratify the severity of illness, provide greater oversight of exception requests, and address concerns regarding patients with durable LVADs.

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“…Heart failure (HF) is associated with significant morbidity, hospitalization burden, and costs in the United States 1,2 . Among patients hospitalized with acute HF, patient socioeconomic status (SES) has been associated with differences in in‐hospital costs and in‐hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Heart failure (HF) is associated with significant morbidity, hospitalization burden, and costs in the United States. 1,2 Among patients hospitalized with acute HF, patient socioeconomic status (SES) has been associated with differences in in-hospital costs and in-hospital mortality. Whether similar disparities exist among patients undergoing complex and costly advanced therapies for HF including implantation of durable left ventricular assist devices (LVAD) and heart transplantation (HT) has not been well characterized.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic status and in‐hospital outcomes for patients undergoing heart transplantation or ventricular assist device implantation

Minhas,

Fudim,

Garan

et al. 2023

Clinical Transplantation

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IntroductionAlthough lower socioeconomic status (SES) has been associated with worse in‐hospital outcomes among patients with heart failure, the in‐hospital outcomes for patients undergoing durable Left Ventricular Assist Device (LVAD) implantation or Heart Transplantation (HT) based on SES have not been well characterized.MethodsWe analyzed data from the National Inpatient Sample of hospitalizations between January 2016 and December 2020 of patients aged 18 and over who underwent a HT or newly implanted LVAD. Quartile classification of the median household income of the patient's residential zip code was used to estimate SES. Multivariable analyses with logistic and linear regression were used to evaluate the effects of SES on inpatient outcomes including inpatient mortality, length of stay, and key inpatient complications.ResultsA total of 16,265 weighted hospitalizations for new LVAD implantation and 14,320 weighted hospitalizations for HT were identified. In multivariable analysis, among patients undergoing HT or LVAD implantation respectively, there were no significant differences between the lowest and highest SES quartiles among important in‐hospital outcomes including length of stay (adj B‐coeff .56, (−3.59)–(4.71), p = .79 and adj B‐coeff 2.40, (−.21)–(5.02), p = .07) and mortality (aOR 1.02, .61–1.70, p = .94 and aOR 1.08, .72–1.62, p = .73). There were also no differences based on SES quartile in important inpatient complications including stroke and cardiac arrest.ConclusionIn this analysis from the National Inpatient Sample, we demonstrate that SES, evaluated by median zip code income, was not associated with important in‐hospital metrics including mortality and length of stay among patients undergoing LVAD or HT.

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Impact of the heart transplant allocation policy change on inpatient cost of index hospitalization

Cited by 10 publications

References 10 publications

Health care resource utilization and clinical outcomes for adult heart transplant recipients with primary graft dysfunction

Health care resource utilization and clinical outcomes for adult heart transplant recipients with primary graft dysfunction

Challenges with the current United Network for Organ Sharing heart allocation system

Socioeconomic status and in‐hospital outcomes for patients undergoing heart transplantation or ventricular assist device implantation

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