Kaslow Whitney W, Jaworski Nancy A, Crawford Courtney, Taylor Katherine, Bearl David W, Dodd Debra, Godown Justin
Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
Pediatr Transplant. 2023 Jun;27(4):e14523. doi: 10.1111/petr.14523. Epub 2023 Apr 10.
Heart transplantation in children is associated with high resource utilization. However, the financial burden on families and the association with patient and demographic factors remains unclear. This study aims to examine out-of-pocket expenses associated with pediatric heart transplantation.
An anonymous REDCap survey was distributed to caregivers of children who have undergone heart transplantation using social media, national organizations, and during clinic encounters from May through August 2022.
There were a total of 146 respondents. The median monthly out-of-pocket expense was $250 (IQR $75-$500) and 20 respondents (13.7%) reported monthly expenses of >$1000. Families with commercial insurance reported significantly higher out-of-pocket expenses compared to those with government-sponsored insurance (median $350 vs. $100, p < .001). Families with government-sponsored insurance were most happy with their insurance coverage, followed by commercial insurance and then coverage through the Affordable Care Act (p < .001 for all pairwise comparisons). There was no statistically significant difference in overall transplant-related out-of-pocket expenses based on total household income (p = .222). Monthly out-of-pocket expense was not associated with the number of medications, type of immunosuppressants, or post-transplant complications including rejection, PTLD, or CAV (p = NS for all). Cardiac catheterizations and unplanned admissions were reported as the events that incurred the highest out-of-pocket expense.
Families of children who have undergone heart transplantation can incur significant out-of-pocket expenses and strategies to mitigate this financial burden should be investigated.
儿童心脏移植与高资源利用率相关。然而，家庭的经济负担以及与患者和人口统计学因素的关联仍不明确。本研究旨在调查与小儿心脏移植相关的自付费用。
2022年5月至8月期间，通过社交媒体、全国性组织以及门诊问诊，向接受过心脏移植的儿童的照料者发放了一份匿名的REDCap调查问卷。
共有146名受访者。每月自付费用的中位数为250美元（四分位距为75美元至500美元），20名受访者（13.7%）报告每月费用超过1000美元。与拥有政府资助保险的家庭相比，拥有商业保险的家庭报告的自付费用显著更高（中位数分别为350美元和100美元，p < 0.001）。拥有政府资助保险的家庭对其保险覆盖最满意，其次是商业保险，然后是通过《平价医疗法案》获得的保险覆盖（所有两两比较的p < 0.001）。基于家庭总收入，总体移植相关自付费用没有统计学上的显著差异（p = 0.222）。每月自付费用与药物数量、免疫抑制剂类型或移植后并发症（包括排斥反应、移植后淋巴组织增生性疾病或冠状动脉粥样硬化性血管病）无关（所有p均为无统计学意义）。心脏导管插入术和计划外住院被报告为产生最高自付费用的事件。
接受过心脏移植的儿童家庭可能会产生大量自付费用，应研究减轻这种经济负担的策略。
