Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany.
Transpl Int. 2017 Jun;30(6):621-637. doi: 10.1111/tri.12950.
To control treatment pathways of transplant patients across healthcare sectors, a profound knowledge of the underlying cost structure is necessary. The aim of this study was to analyze the resource utilization of patients undergoing liver transplantation. Data on resource utilization for 182 liver-transplanted patients was investigated retrospectively. The observational period started with the entry on the waiting list and ended up to 3 years after transplantation. Median treatment cost was 144 424€. During waiting time, median costs amounted to 9466€; 72% of costs were attributed to inpatient care, 3% to outpatient care, and 26% to pharmaceuticals. During the first year after transplantation, median costs of 105 566€ were calculated; 83% were allocated for inpatient and 1% outpatient care, 14% for drugs, and 1% for rehabilitative care. During follow-up after the first year of transplantation, median costs amounted to 20 115€; 75% of these were caused by pharmaceuticals, 21% by inpatient, 4% by outpatient, and <1% by rehabilitative services. Subgroup analyses (e.g., for labMELD scores) were done. Costs incurred by inpatient care and pharmaceuticals are the dominating cost factors. These findings encourage a debate on challenges and improvements for cost-efficient clinical management between different healthcare sectors.
为了控制跨医疗领域的移植患者的治疗途径，需要深入了解潜在的成本结构。本研究旨在分析肝移植患者的资源利用情况。回顾性调查了 182 例肝移植患者的资源利用数据。观察期从进入候补名单开始，到移植后 3 年结束。中位治疗费用为 144424 欧元。等待期间的中位费用为 9466 欧元；72%的费用用于住院治疗，3%用于门诊治疗，26%用于药品。移植后第一年的中位费用为 105566 欧元；83%用于住院和 1%门诊治疗，14%用于药物，1%用于康复治疗。移植后第一年的随访期间，中位费用为 20115 欧元；其中 75%是药物费用，21%是住院费用，4%是门诊费用，<1%是康复服务费用。进行了亚组分析（例如，实验室 MELD 评分）。住院治疗和药品费用是主要的成本因素。这些发现鼓励不同医疗领域之间就提高成本效益的临床管理的挑战和改进进行讨论。
