Buchanan Paula, Dzebisashvili Nino, Lentine Krista L, Axelrod David A, Schnitzler Mark A, Salvalaggio Paolo R
Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
Liver Transpl. 2009 Oct;15(10):1270-7. doi: 10.1002/lt.21802.
We examined the relationship between the total cost incurred by liver transplantation (LT) recipients and their Model for End-Stage Liver Disease (MELD) score at the time of transplant. We used a novel database linking billing claims from a large private payer with the Organ Procurement and Transplantation Network registry. Included were adults who underwent LT from March 2002 through August 2007 (n = 990). Claims within the year preceding and following transplantation were analyzed according to the recipient's calculated MELD score. Cost was the primary endpoint and was assessed by the length of stay and charges. Transplant admission charges represented approximately 50% of the total cost of LT. MELD was a significant cost driver for pretransplant, transplant, and total charges. A MELD score of 28 to 40 was associated with additional charges of $349,213 (P < 0.05) in comparison with a score of 15 to 20. Pretransplant and transplant admission charges were higher by $152,819 (P < 0.05) and $64,286 (P < 0.05), respectively, in this higher MELD group. No differences by MELD score were found for posttransplant charges. Those in the highest MELD group also experienced longer hospital stays both in the pretransplant period and at the time of LT but did not have higher rates of re-admissions. In conclusion, high-MELD patients incur significantly higher costs prior to and at the time of LT. Following LT, the MELD score is not a significant predictor of cost or re-admission.
我们研究了肝移植（LT）受者产生的总费用与其移植时的终末期肝病模型（MELD）评分之间的关系。我们使用了一个新颖的数据库，该数据库将来自大型私人支付方的计费索赔与器官获取和移植网络登记处相链接。纳入的患者为2002年3月至2007年8月期间接受肝移植的成年人（n = 990）。根据受者计算出的MELD评分，分析移植前后一年内的索赔情况。费用是主要终点，通过住院时间和收费来评估。移植入院费用约占肝移植总费用的50%。MELD是移植前、移植及总费用的一个重要费用驱动因素。与15至20分的评分相比，28至40分的MELD评分与额外费用349,213美元相关（P < 0.05）。在这个较高MELD组中，移植前和移植入院费用分别高出152,819美元（P < 0.05）和64,286美元（P < 0.05）。未发现移植后费用在MELD评分上存在差异。MELD评分最高组的患者在移植前和肝移植时的住院时间也更长，但再入院率并不更高。总之，高MELD评分患者在肝移植前和肝移植时产生的费用显著更高。肝移植后，MELD评分不是费用或再入院的显著预测指标。
