Votapka T V, Swartz M T, Reedy J E, Lohmann D P, McBride L R, Miller L W, Pennington D G
Division of Cardiothoracic Surgery, St. Louis University Health Sciences Center, MO 63110-0250, USA.
J Heart Lung Transplant. 1995 Mar-Apr;14(2):366-72.
The current health care environment mandates closer scrutiny of health care dollar allocation. To better understand the distribution of heart transplantation costs, we reviewed hospital and physician billing of patients who underwent orthotopic heart transplantation between August 1988 and September 1993.
This study is a retrospective review of 107 consecutive cases. Charges and clinical results of United Network for Organ Sharing status 1 patients (n = 46), including 17 bridge to transplantation patients, were compared with those of United Network for Organ Sharing status 2 patients (n = 57). Charges were converted to 1992 dollars.
During the first 12 months of the study, 77% of heart transplantations were performed in United Network for Organ Sharing status 2 patients, whereas over the last 12-month period, 25% of the transplantations were performed in status 2 patients. No significant differences were found in age, gender, type of cardiomyopathy, or survival between the status 1 and status 2 groups. The length of hospitalization for the status 1 group ranged from 8 to 138 days (mean 49 days) as opposed to 5 to 82 days (mean 17.5 days) for the status 2 group (p < 0.0001). Pretransplantation hospital charges were significantly higher for the status 1 group ($47,917 to $341,215, mean $109,116) when compared with status 2 ($0 to $10,035, mean $250) (p < 0.0001). No significant difference was found in posttransplantation hospital charges between status 1 ($47,917 to $210,027, mean $95,379) and status 2 patients ($48,093 to $380,745, mean $102,265). Total charges were significantly higher (p < 0.0001) for the status 1 group ($89,910 to $512,331, mean $239,375) when compared with the status 2 group ($63,885 to $455,680, mean $128,594). Total transplantation charges for the study period were $18,341,108. This amount could have paid for 77 status 1 transplantations or 143 status 2 transplantations.
If current trends continue and the donor pool remains the same, most transplant recipients will be status 1, resulting in a comparable number of transplantations performed at twice the charges.
当前的医疗保健环境要求对医疗保健资金分配进行更严格的审查。为了更好地了解心脏移植成本的分布情况，我们回顾了1988年8月至1993年9月期间接受原位心脏移植患者的医院和医生账单。
本研究是对107例连续病例的回顾性研究。将器官共享联合网络1级患者（n = 46）的费用和临床结果，包括17例移植过渡患者，与器官共享联合网络2级患者（n = 57）的费用和临床结果进行比较。费用换算为1992年美元。
在研究的前12个月，77%的心脏移植手术是在器官共享联合网络2级患者中进行的，而在最后12个月期间，25%的移植手术是在2级患者中进行的。1级和2级组在年龄、性别、心肌病类型或生存率方面没有显著差异。1级组的住院时间为8至138天（平均49天），而2级组为5至82天（平均17.5天）（p < 0.0001）。1级组移植前的医院费用显著高于2级组（47,917美元至341,215美元，平均109,116美元），而2级组为0至10,035美元，平均250美元（p < 0.0001）。1级组（47,917美元至210,027美元，平均95,379美元）和2级组患者（48,093美元至380,745美元，平均102,265美元）移植后的医院费用没有显著差异。1级组的总费用（89,910美元至512,331美元，平均239,375美元）显著高于2级组（63,885美元至45,680美元，平均128,594美元）（p < 0.0001）。研究期间的总移植费用为18,341,108美元。这笔钱可以支付77例1级移植手术或143例2级移植手术。
如果当前趋势持续，供体库保持不变，大多数移植受者将为1级，导致移植手术数量相当，但费用增加一倍。
