Russo M W, Sandler R S, Mandelkehr L, Fair J H, Johnson M W, Brown R S
Liver Transplant Program, University of North Carolina, Chapel Hill, NC, USA.
Liver Transpl Surg. 1998 Sep;4(5):370-7. doi: 10.1002/lt.500040510.
Prior studies evaluating the impact of race and payer on cost of liver transplantation did not adjust for clinical factors known to increase cost. We analyzed the impact of race and payer on the cost of liver transplantation after controlling for clinical factors. We analyzed data obtained on patient and graft survival, cost, race, age, sex, payer, and United Network for Organ Sharing (UNOS) status from 153 consecutive liver transplants in 130 patients performed at University of North Carolina Hospitals from September 1991 through December 1996. Race was classified as white or nonwhite, and payer status was classified as commercial or Medicare/Medicaid. Multivariate linear regression was used to compare costs, adjusting for age, sex, race, payer, and UNOS status. For the 130 patients, 1-year patient and graft survival rates were 88% and 82%, respectively. There were no significant differences in patient and graft survival or in the unadjusted average cost of liver transplantation by race or payer. After adjusting for demographic and clinical factors, the cost of transplantation was $28,494 more for Medicare/Medicaid recipients compared with the commercial insurance recipients (P = .02). The Medicare/Medicaid group had higher intensive care unit costs compared with the commercial insurance group ($17,807 and $9,359, respectively; P = .03), and a longer length of stay (41 and 31 days, respectively; P = .04). There was no significant difference in cost between whites and nonwhites adjusting for these factors. Medicare or Medicaid patients had a higher cost of transplantation compared with those with commercial insurance. The cost of liver transplantation was similar for whites and nonwhites.
此前评估种族和付款人对肝移植成本影响的研究未对已知会增加成本的临床因素进行调整。我们在控制临床因素后分析了种族和付款人对肝移植成本的影响。我们分析了1991年9月至1996年12月在北卡罗来纳大学医院为130名患者进行的153例连续肝移植中获得的患者和移植物存活、成本、种族、年龄、性别、付款人以及器官共享联合网络（UNOS）状态的数据。种族分为白人或非白人，付款人状态分为商业保险或医疗保险/医疗补助。使用多元线性回归比较成本，并对年龄、性别、种族、付款人和UNOS状态进行调整。对于这130名患者，1年患者和移植物存活率分别为88%和82%。种族或付款人在患者和移植物存活以及肝移植未调整平均成本方面没有显著差异。在对人口统计学和临床因素进行调整后，医疗保险/医疗补助接受者的移植成本比商业保险接受者高28,494美元（P = .02）。与商业保险组相比，医疗保险/医疗补助组的重症监护病房成本更高（分别为17,807美元和9,359美元；P = .03），住院时间更长（分别为41天和31天；P = .04）。在对这些因素进行调整后，白人和非白人之间的成本没有显著差异。医疗保险或医疗补助患者的移植成本高于商业保险患者。白人和非白人的肝移植成本相似。
