Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
The European Journal of Health Economics
Erschienen in: The European Journal of Health Economics 2/2019

26.07.2018 | Original Research

Potential savings in the treatment pathway of liver transplantation: an inter-sectorial analysis of cost-rising factors

verfasst von: Lena Harries, Jill Gwiasda, Zhi Qu, Harald Schrem, Christian Krauth, Volker Eric Amelung

Erschienen in: The European Journal of Health Economics | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Identification of cost-driving factors in patients undergoing liver transplantation is essential to target reallocation of resources and potential savings.

Aim

The aim of this study is to identify main cost-driving factors in liver transplantation from the perspective of the Statutory Health Insurance.

Methods

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.

Results

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 €.

Conclusions

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.
Literatur
1.
Harries, L., Schrem, H., Stahmeyer, J.T., Krauth, C., Amelung, V.E.: High resource utilization in liver transplantation—how strongly differ costs between the care sectors and what are the main cost drivers?: a retrospective study. Transpl. Int. 30(6), 621–637 (2017)CrossRefPubMed
2.
Aberg, F., Maklin, S., Rasanen, P., Roine, R.P., Sintonen, H., Koivusalo, A.M., et al.: Cost of a quality-adjusted life year in liver transplantation: the influence of the indication and the model for end-stage liver disease score. Liver Transpl. 17(11), 1333–1343 (2011)CrossRefPubMed
3.
van der Hilst, C.S., Ijtsma, A.J., Slooff, M.J., Tenvergert, E.M.: Cost of liver transplantation: a systematic review and meta-analysis comparing the United States with other OECD countries. Med. Care Res. Rev. 66(1), 3–22 (2009)CrossRefPubMed
4.
Kraus, T.W., Mieth, M., Schneider, T., Farrenkopf, I., Mehrabi, A., Schemmer, P., et al.: Cost distribution of orthotopic liver transplantation: single-center analysis under DRG-based reimbursement. Transplantation 80(1 Suppl), S97 (2005)CrossRefPubMed
5.
Lock, J., Reinhold, T., Bloch, A., Malinowski, M., Schmidt, S.C., Neuhaus, P., et al.: The cost of graft failure and other severe complications after liver transplantation—experience from a German Transplant Center. Ann. Transpl. 15(3), 11–18 (2010)
6.
Longworth, L., Young, T., Buxton, M.J., Ratcliffe, J., Neuberger, J., Burroughs, A., et al.: Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups. Liver Transpl. 9(12), 1295–1307 (2003)CrossRefPubMed
7.
8.
Axelrod, D.A., Dzebisashvili, N., Lentine, K., Segev, D.L., Dickson, R., Tuttle-Newhall, E., et al.: Assessing variation in the costs of care among patients awaiting liver transplantation. Am. J. Transpl. 14(1), 70–78 (2014)CrossRef
9.
Nicolas, C.T., Nyberg, S.L., Heimbach, J.K., Watt, K., Chen, H.S., Hathcock, M.A., et al.: Liver transplantation after share 35: impact on pretransplant and posttransplant costs and mortality. Liver Transpl. 23(1), 11–18 (2017)CrossRefPubMed
10.
Washburn, W.K., Pollock, B.H., Nichols, L., Speeg, K.V., Halff, G.: Impact of recipient MELD score on resource utilization. Am. J. Transpl. 6(10), 2449–2454 (2006)CrossRef
11.
Buchanan, P., Dzebisashvili, N., Lentine, K.L., Axelrod, D.A., Schnitzler, M.A., Salvalaggio, P.R.: Liver transplantation cost in the model for end-stage liver disease era: looking beyond the transplant admission. Liver Transpl. 15(10), 1270–1277 (2009)CrossRefPubMed
12.
Schöffski, O., von der Schulenburg, J.M.G. (eds): Gesundheitsökonomische evaluation, 4th edn. Springer, Berlin(2012)
13.
Kersting, W.: Gerechtigkeitsethische Überlegungen zur Gesundheitsversorgung. In: Schöffski, O., von der Schulenburg, J.M.G. (eds) Gesundheitsökonomische evaluation, 4th edn, pp. 23–47. Springer, Berlin (2012)
14.
Quan, H., Li, B., Couris, C.M., Fushimi, K., Graham, P., Hider, P., et al.: Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6), 676–682 (2011)CrossRefPubMed
15.
Wasilewicz, M., Raszeja-Wyszomirska, J., Wunsch, E., Wójcicki, M., Milkiewicz, P.: Modified Charlson Comorbidity Index in predicting early mortality after liver transplantation. Transpl. Proc. 41(8):3117–3118 (2009)CrossRef
16.
Xu, Y., Li, N., Lu, M., Dixon, E., Myers, R.P., Jolley, R.J., et al.: Comparison of risk adjustment methods in patients with liver disease using electronic medical record data. BMC Gastroenterol. 17(1), 5 (2017)CrossRefPubMedPubMedCentral
17.
Volk, M.L., Hernandez, J.C., Lok, A.S., Marrero, J.A.: Modified Charlson comorbidity index for predicting survival after liver transplantation. Liver Transpl. 13(11), 1515–1520 (2007)CrossRefPubMed
18.
Wang, C.-Y., Lin, Y.-S., Tzao, C., Lee, H.-C., Huang, M.-H., Hsu, W.-H., et al.: Comparison of Charlson comorbidity index and Kaplan–Feinstein index in patients with stage I lung cancer after surgical resection. Eur. J. Cardiothorac. Surg. 32(6), 877–881 (2007)CrossRefPubMed
19.
20.
21.
Hosmer, D.W., Lemeshow, S., Sturdivant, R.X.: Applied logistic regression. Wiley series in probability and statistics, vol 398, 3rd edn. Hoboken:Wiley (2013)CrossRef
22.
Charlson, M., Wells, M.T., Ullman, R., King, F., Shmukler, C.: The Charlson comorbidity index can be used prospectively to identify patients who will incur high future costs. PloS One 9(12), e112479 (2014)CrossRefPubMedPubMedCentral
23.
Backhaus, K., Erichson, B., Plinke, W., Weiber, R.: Multivariate Analysemethoden. 14. Aufl. Berlin:Springer (2016) (Imprint: Springer Gabler) CrossRef
24.
Perkins, A.J., Kroenke, K., Unützer, J., Katon, W., Williams, J.W., Hope, C., et al.: Common comorbidity scales were similar in their ability to predict health care costs and mortality. J. Clin. Epidemiol. 57(10), 1040–1048 (2004)CrossRefPubMed
25.
Kothari, A.N., Yau, R.M., Blackwell, R.H., Schaidle-Blackburn, C., Markossian, T., Zapf, M.A., et al.: Inpatient rehabilitation after liver transplantation decreases risk and severity of 30-day readmissions. J. Am. Coll. Surg. 223(1), 164–171.e2 (2016)CrossRefPubMedPubMedCentral
26.
Brand, D.A., Viola, D., Rampersaud, P., Patrick, P.A., Rosenthal, W.S., Wolf, D.C.: Waiting for a liver—hidden costs of the organ shortage. Liver Transpl. 10(8), 1001–1010 (2004)CrossRefPubMed
27.
Turri, J.A.O., Decimoni, T.C., Ferreira, L.A., Diniz, M.A., Haddad, L. B., Campolina A.G.: Higher MELD score increases the overall cost on the waiting list for liver transplantation: a micro-costing analysis based study. Arq. Gastroenterol. 54(3), 238–245 (2017)CrossRefPubMed
28.
29.
30.
Rostved, A.A., Lundgren, J.D., Hillingsø, J., Peters, L., Mocroft, A., Rasmussen, A.: MELD score measured day 10 after orthotopic liver transplantation predicts death and re-transplantation within the first year. Scand. J. Gastroenterol. 51(11), 1360–1366 (2016)CrossRefPubMed
31.
Harries, L., Schrem, H., Krauth, C., Amelung, V.E.: Pathways in transplantation medicine—challenges in overcoming interfaces between cross-sectoral care structures. In: Amelung, V., Stein, V., Goodwin, N., Baliver, R., Nolte, E., Suter, E. (eds.) Handbook integrated care, pp. 429–438. Springer, Cham (2017)CrossRef
32.
Schrem, H., Focken, M., Gunson, B., Reichert, B., Mirza, D., Kreipe, H.H., et al.: The new liver allocation score for transplantation is validated and improved transplant survival benefit in Germany but not in the United Kingdom. Liver Transpl. 22(6), 743–756 (2016)CrossRefPubMed
33.
Braat, A.E., Blok, J.J., Putter, H., Adam, R., Burroughs, A.K., Rahmel, A.O., et al.: The Eurotransplant donor risk index in liver transplantation: ET-DRI. Am.J.Transpl. 12(10), 2789–2796 (2012)CrossRef
34.
Showstack, J., Katz, P.P., Lake, J.R., Brown, R.S., Dudley, R.A., Belle, S., et al.: Resource utilization in liver transplantation: effects of patient characteristics and clinical practice. NIDDK Liver Transplantation Database Group. JAMA 281(15), 1381–1386 (1999)CrossRefPubMed
35.
36.
37.
Henson, J.B., Patel, Y.A., Wilder, J.M., Zheng, J., Chow, S.-C., King, L.Y., et al.: Differences in phenotypes and liver transplantation outcomes by age group in patients with primary sclerosing cholangitis. Digest. Dis. Sci. 62, 3200–3209 (2017)CrossRefPubMed
Metadaten
Titel
Potential savings in the treatment pathway of liver transplantation: an inter-sectorial analysis of cost-rising factors
verfasst von
Lena Harries
Jill Gwiasda
Zhi Qu
Harald Schrem
Christian Krauth
Volker Eric Amelung
Publikationsdatum
26.07.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
The European Journal of Health Economics / Ausgabe 2/2019
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-018-0994-y

Weitere Artikel der Ausgabe 2/2019

The European Journal of Health Economics 2/2019 Zur Ausgabe

Original Paper

The association of potentially inappropriate medication use on health outcomes and hospital costs in community-dwelling older persons: a longitudinal 12-year study

Editorial

When is it too expensive? Cost-effectiveness thresholds and health care decision-making

Original Paper

Catastrophic financial effect of replacing informal care with formal care: a study based on haematological neoplasms

Original Paper

A new method for valuing health: directly eliciting personal utility functions

Original Paper

Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries

Original Paper

Costs of dose escalation among ulcerative colitis patients treated with adalimumab in Germany