Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
Liver Transpl. 2023 Jun 1;29(6):626-643. doi: 10.1097/LVT.0000000000000063. Epub 2023 Jan 3.
This study aims to evaluate recent annualized trends in the cost-burden of inpatient hospitalizations associated with liver transplantation (LT) in the US as stratified by patient demographics and medical characteristics. From 2016 to 2019 National Inpatient Sample was used to select patients who underwent LT, from which the weighted charge estimates were derived and converted to admission costs using inflation-adjusted charge-to-cost ratios. The adjusted values were stratified using select patient variables and graphed across the respective years to derive goodness-of-fit for each trend (expressed with R2 and p -values). From 2016 to 2019, the estimated total number of LT-related hospitalizations in the US were 6685, 7075, 7260, and 7815 cases respectively. There was a general increase in the total cost of LT-related hospitalizations over the years: $945.75, $1010.23, $1052.46, and $1143.84 in millions of dollars (0.98, 0.01). Furthermore, positive trends in total cost were observed in the following strata: patients aged 35-49 (0.92, 0.04) and above 65 (0.91, 0.05), Whites (0.99, 0.01), those with congestive heart failure (0.98, 0.01), ≥2 comorbidities (0.97, 0.02), hepatic encephalopathy (0.93, 0.04), and those with private insurance (0.93, 0.04), as well as LT performed in the Northeast (0.94, 0.03), Midwest (0.92, 0.04), and South (0.91, 0.04). Total cost associated with hepatitis C declined significantly (0.94, 0.03). With respect to mean costs, positive trends were observed in the following strata: those with other or cryptogenic liver disease (0.93, 0.03), ≥2 comorbidities (0.96, 0.02), and LT performed in the Northeast region (0.93, 0.04). The number of liver transplants performed in the US, as well as the associated costs, are rising. Given the apparent rising costs in specific patient populations, economic and public health policies must focus on cost containment within these groups to ensure appropriate usage of resources.
本研究旨在评估美国肝移植（LT）相关住院费用的年度变化趋势，这些趋势按患者人口统计学和医疗特征进行分层。利用 2016 年至 2019 年的国家住院患者样本选择接受 LT 的患者，从这些患者中得出加权费用估计数，并使用通胀调整后的费用与成本比将其转换为入院费用。使用选定的患者变量对调整后的数值进行分层，并根据各自的年份绘制图表，以确定每种趋势的拟合优度（用 R2 和 p 值表示）。2016 年至 2019 年，美国 LT 相关住院治疗的估计总人数分别为 6685、7075、7260 和 7815 例。多年来，LT 相关住院治疗的总费用总体呈上升趋势：9.4575 亿美元、10.1023 亿美元、10.5246 亿美元和 11.4384 亿美元（0.98、0.01）。此外，在以下分层中观察到总费用呈正增长趋势：35-49 岁（0.92、0.04）和 65 岁以上（0.91、0.05）的患者、白人（0.99、0.01）、充血性心力衰竭（0.98、0.01）、≥2 种合并症（0.97、0.02）、肝性脑病（0.93、0.04）和私人保险（0.93、0.04），以及东北地区（0.94、0.03）、中西部地区（0.92、0.04）和南部地区（0.91、0.04）进行的 LT。丙型肝炎相关总费用显著下降（0.94、0.03）。关于平均费用，以下分层呈正增长趋势：其他或隐匿性肝病（0.93、0.03）、≥2 种合并症（0.96、0.02）和东北地区进行的 LT（0.93、0.04）。美国进行的肝移植数量以及相关费用正在增加。鉴于特定患者群体中明显上升的成本，经济和公共卫生政策必须专注于这些群体的成本控制，以确保资源的合理使用。
