Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA.
J Heart Lung Transplant. 2012 May;31(5):485-91. doi: 10.1016/j.healun.2011.12.008. Epub 2012 Feb 4.
Heart transplantation remains a resource-intensive therapy for children. However, data regarding change in costs over time are scarce. We tested the hypothesis that hospital charges for pediatric heart transplant hospitalizations would increase from 1997 to 2006 and assessed factors associated with hospital charges.
A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed on admissions surrounding heart transplantation for the years 1997, 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates.
There were 353 (95% confidence interval, 201-505) pediatric heart transplants in 1997 and 355 (95% confidence interval, 226-485) in 2006. Mean hospital charges increased from $279,399 in 1997 to $451,738 in 2006 (p < 0.001). This increase was similar to that observed for other pediatric surgical diseases. Increases also occurred in morbidities, including pulmonary hypertension (p = 0.04) and sepsis (p = 0.04), and in the use of extracorporeal membrane oxygenation (p = 0.03). On multivariable analysis, greater hospital charges were associated with later calendar year (p = 0.001), stroke (p = 0.03), sepsis (p = 0.001), renal failure (p = 0.008), arrhythmia (p = 0.03), and use of extracorporeal membrane oxygenation (p < 0.001) and ventricular assist device (p < 0.001).
From 1997 to 2006, mean charges for pediatric heart transplant hospitalizations increased by > $170,000 (160%). Although greater morbidities in the later years of the study potentially contributed to increased charges, later calendar year was independently associated with increased charges. The changes in charges for heart transplant are similar to the increases seen in other surgical procedures. Ongoing study of management strategies is needed to determine cost-effective therapies for this complex group of patients.
心脏移植仍然是一种资源密集型的儿童治疗方法。然而，关于成本随时间变化的数据却很少。我们检验了以下假设，即儿科心脏移植住院费用将从 1997 年到 2006 年增加，并评估了与住院费用相关的因素。
对 1997 年、2000 年、2003 年和 2006 年心脏移植相关的医疗保健成本和利用项目儿童住院数据库进行回顾性分析。该数据库是儿科医院出院的全国性抽样调查，经过加权处理可提供全国性估计。
1997 年有 353 例（95%置信区间，201-505）儿科心脏移植，2006 年有 355 例（95%置信区间，226-485）。医院收费从 1997 年的 279399 美元增加到 2006 年的 451738 美元（p < 0.001）。这种增长与其他儿科手术疾病的增长相似。包括肺动脉高压（p = 0.04）和败血症（p = 0.04）在内的发病率以及体外膜氧合（ECMO）的使用（p = 0.03）也有所增加。多变量分析表明，较高的医院收费与较晚的日历年份（p = 0.001）、中风（p = 0.03）、败血症（p = 0.001）、肾衰竭（p = 0.008）、心律失常（p = 0.03）和体外膜氧合（p < 0.001）和心室辅助装置（p < 0.001）的使用有关。
从 1997 年到 2006 年，儿科心脏移植住院费用平均增加超过 170,000 美元（增长 160%）。尽管研究后期发病率较高可能导致费用增加，但较晚的日历年份与费用增加独立相关。心脏移植费用的变化与其他手术程序的增加相似。需要对管理策略进行持续研究，以确定针对这一复杂患者群体的成本效益疗法。
