Lock Johan, Reinhold Thomas, Bloch Andy, Malinowski Maciej, Schmidt Sven-Christian, Neuhaus Peter, Stockmann Martin
Department of General, Visceral and Transplantion Surgery, Charité - Universitätsmedizin Berlin, Germany.
Ann Transplant. 2010 Jul-Sep;15(3):11-8.
Orthotopic liver transplantation (OLT) is a cost consuming therapy for only a relatively small number of patients. The aim of the present study was to explore specific cost drivers in a German transplant centre.
MATERIAL/METHODS: The analysis was done by combination of two separate databases with prospective clinical and case-related cost data. Several complications were compared for their impact on length of stay and on costs by uni- and multivariate analysis.
The median cost of OLT was 30,120 Euro (range 18,330-397,450; mean 52,570), the median reimbursement was 33,227 Euro (range 30,879-344,142; mean 59,628) with a significant in-between correlation of r=0.951 (P<0.0001). Post-transplant complications significantly raised cost, with an increase of 62% by vascular complications, 175% by renal failure, 207% by biliary leakage, 227% by graft failure and 234% by sepsis. Multivariate analysis revealed reoperation, hypotension and graft failure as independent cost factors. Graft failure contributed for mean additional costs of 105,911 Euro (95%CI 75,695 to 136,126). In particular, the cost of ICU therapy increased from 16,884 Euro up to 92,239 Euro (P<0.0001).
Cost and reimbursement of OLT are relatively moderate in Germany. Graft failure was identified as the major cost-determining factor. The cost impact of post-transplant complications is mainly caused by the length of stay.
原位肝移植（OLT）是一种仅适用于相对少数患者的高成本治疗方法。本研究的目的是探索德国一家移植中心的特定成本驱动因素。
材料/方法：通过将两个分别包含前瞻性临床和病例相关成本数据的数据库相结合进行分析。通过单变量和多变量分析比较了几种并发症对住院时间和成本的影响。
OLT的中位成本为30,120欧元（范围18,330 - 397,450；平均52,570），中位报销金额为33,227欧元（范围30,879 - 344,142；平均59,628），两者之间存在显著的相关性，r = 0.951（P < 0.0001）。移植后并发症显著增加了成本，血管并发症使成本增加62%，肾衰竭使成本增加175%，胆漏使成本增加207%，移植物功能衰竭使成本增加227%，脓毒症使成本增加234%。多变量分析显示再次手术、低血压和移植物功能衰竭是独立的成本因素。移植物功能衰竭导致平均额外成本为105,911欧元（95%置信区间75,695至136,126）。特别是，重症监护治疗的成本从16,884欧元增加到92,239欧元（P < 0.0001）。
在德国，OLT的成本和报销相对适中。移植物功能衰竭被确定为主要的成本决定因素。移植后并发症的成本影响主要由住院时间引起。
