Department of Health Economics and Health Policy, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Core Facility Quality Management Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Eur J Health Econ. 2019 Mar;20(2):281-301. doi: 10.1007/s10198-018-0994-y. Epub 2018 Jul 26.
Identification of cost-driving factors in patients undergoing liver transplantation is essential to target reallocation of resources and potential savings.
The aim of this study is to identify main cost-driving factors in liver transplantation from the perspective of the Statutory Health Insurance.
Variables were analyzed with multivariable logistic regression to determine their influence on high cost cases (fourth quartile) in the outpatient, inpatient and rehabilitative healthcare sectors as well as for medications.
Significant cost-driving factors for the inpatient sector of care were a high labMELD-score (OR 1.042), subsequent re-transplantations (OR 7.159) and patient mortality (OR 3.555). Expenditures for rehabilitative care were significantly higher in patients with a lower adjusted Charlson comorbidity index (OR 0.601). The indication of viral cirrhosis and hepatocellular carcinoma resulted in significantly higher costs for medications (OR 21.618 and 7.429). For all sectors of care and medications each waiting day had a significant impact on high treatment costs (OR 1.001). Overall, cost-driving factors resulted in higher median treatment costs of 211,435 €.
Treatment costs in liver transplantation were significantly influenced by identified factors. Long pre-transplant waiting times that increase overall treatment costs need to be alleviated by a substantial increase in donor organs to enable transplantation with lower labMELD-scores. Disease management programs, the implementation of a case management for vulnerable patients, medication plans and patient tracking in a transplant registry may enable cost savings, e.g., by the avoidance of otherwise necessary re-transplants or incorrect medication.
从法定医疗保险的角度确定肝移植患者的成本驱动因素对于重新分配资源和潜在节约具有重要意义。
本研究旨在从法定医疗保险的角度确定肝移植的主要成本驱动因素。
使用多变量逻辑回归分析变量，以确定它们对外科门诊、住院和康复医疗部门以及药物治疗的高费用病例（第四四分位数）的影响。
护理住院部门的显著成本驱动因素包括较高的实验室 MELD 评分（OR 1.042）、后续再次移植（OR 7.159）和患者死亡率（OR 3.555）。调整后的 Charlson 合并症指数较低的患者，康复护理费用显著较高（OR 0.601）。病毒性肝硬化和肝细胞癌的指征导致药物治疗费用显著增加（OR 21.618 和 7.429）。对于所有护理和药物治疗部门，每等待一天都会对高治疗费用产生显著影响（OR 1.001）。总体而言，成本驱动因素导致中位治疗费用增加 211,435 欧元。
肝移植的治疗费用受到确定因素的显著影响。通过大量增加供体器官，以降低实验室 MELD 评分进行移植，可以缓解移植前等待时间长导致的总体治疗费用增加的问题。疾病管理计划、为弱势患者实施病例管理、药物治疗计划以及在移植登记处对患者进行跟踪，可能会节省成本，例如避免不必要的再次移植或错误的药物治疗。
