The Medical Costs of Determining Eligibility and Waiting for a Kidney Transplantation

Bibliographic Data

ID9100306
AuthorsKunyao Xu (0009-0002-5086-6884, George Washington University, corresponding author), Avi Dor (0000-0003-4475-4333, George Washington University, corresponding author), Suman Mohanty (Vanderbilt University, Nashville, TN), Suman Sundar Mohanty (0000-0002-2327-7112, Vanderbilt University), Jialin Han (0000-0001-5731-8974, University of British Columbia), Gomathy Parvathinathan (0000-0002-5156-8566, Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA), Jennifer L Braggs-Gresham (University of Michigan), Philip J Held (0000-0002-6436-3746, Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA), John P Roberts (0000-0003-3303-9406, University of California, San Francisco), William Vaughan (Transplant Solutions LLC, Tampa, FL), William P Vaughan (Milken Institute, corresponding author), Jane C Tan (0000-0002-3169-2148, Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA), John D Scandling (0000-0001-6493-3318, Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA), Glenn M Chertow (0000-0002-7599-0534, Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA), Stephan Busque (0000-0003-1048-1621, Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Palo Alto, CA), Xingxing S Cheng (0000-0002-0542-8749, Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA)
Year2024
Volume62
Issue8
Pages521-529
Publication date2024-08-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000002028
PMID38889200
OpenAlexW4399767466
LanguageEN
References cited20

BACKGROUND: Recent efforts to increase access to kidney transplant (KTx) in the United States include increasing referrals to transplant programs, leading to more pretransplant services. Transplant programs reconcile the costs of these services through the Organ Acquisition Cost Center (OACC). OBJECTIVE: The aim of this study was to determine the costs associated with pretransplant services by applying microeconomic methods to OACC costs reported by transplant hospitals. RESEARCH DESIGN, SUBJECTS, AND MEASURES: For all US adult kidney transplant hospitals from 2013 through 2018 (n=193), we crosslinked the total OACC costs (at the hospital-fiscal year level) to proxy measures of volumes of pretransplant services. We used a multiple-output cost function, regressing total OACC costs against proxy measures for volumes of pretransplant services and adjusting for patient characteristics, to calculate the marginal cost of each pretransplant service. RESULTS: Over 1015 adult hospital-years, median OACC costs attributable to the pretransplant services were $5 million. Marginal costs for the pretransplant services were: initial transplant evaluation, $9k per waitlist addition; waitlist management, $2k per patient-year on the waitlist; deceased donor offer management, $1k per offer; living donor evaluation, procurement and follow-up: $26k per living donor. Longer time on dialysis among patients added to the waitlist was associated with higher OACC costs at the transplant hospital. CONCLUSIONS: To achieve the policy goals of more access to KTx, sufficient funding is needed to support the increase in volume of pretransplant services. Future studies should assess the relative value of each service and explore ways to enhance efficiency

Business · Dialysis · Intensive care medicine · Marginal cost · Procurement · Proxy (statistics) · Dialysis and Renal Disease Management · Emergency Medicine · Internal Medicine · Medicine · Organ Donation and Transplantation · Renal Transplantation Outcomes and Treatments · Transplantation

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