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Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017
IMPORTANCE: While recent policy reforms aim to improve access to kidney transplantation for patients with end-stage kidney disease, the cost implications of kidney waiting list expansion are not well understood. The Organ Acquisition Cost Center (OACC) is the mechanism by which Medicare reimburses k...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914579/ https://www.ncbi.nlm.nih.gov/pubmed/35267033 http://dx.doi.org/10.1001/jamanetworkopen.2022.1847 |
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author | Cheng, Xingxing S. Han, Jialin Braggs-Gresham, Jennifer L. Held, Philip J. Busque, Stephan Roberts, John P. Tan, Jane C. Scandling, John D. Chertow, Glenn M. Dor, Avi |
author_facet | Cheng, Xingxing S. Han, Jialin Braggs-Gresham, Jennifer L. Held, Philip J. Busque, Stephan Roberts, John P. Tan, Jane C. Scandling, John D. Chertow, Glenn M. Dor, Avi |
author_sort | Cheng, Xingxing S. |
collection | PubMed |
description | IMPORTANCE: While recent policy reforms aim to improve access to kidney transplantation for patients with end-stage kidney disease, the cost implications of kidney waiting list expansion are not well understood. The Organ Acquisition Cost Center (OACC) is the mechanism by which Medicare reimburses kidney transplantation programs, at cost, for costs attributable to kidney transplantation evaluation and waiting list management, but these costs have not been well described to date. OBJECTIVES: To describe temporal trends in mean OACC costs per kidney transplantation and to identify factors most associated with cost. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation included all kidney transplantation waiting list candidates and recipients in the United States from 2012 to 2017. A population-based study of cost center reports was conducted using data from all Center of Medicare & Medicaid–certified transplantation hospitals. Data analysis was conducted from June to August 2021. EXPOSURES: Year, local price index, transplantation and waiting list volume of transplantation program, and comorbidity burden. MAIN OUTCOMES AND MEASURES: Mean OACC costs per kidney transplantation. RESULTS: In 1335 hospital-years from 2012 through 2017, Medicare’s share of OACC costs increased from $0.95 billion in 2012 to $1.32 billion in 2017 (3.7% of total Medicare End-Stage Renal Disease program expenditure). Median (IQR) OACC costs per transplantation increased from $81 000 ($66 000 to $103 000) in 2012 to $100 000 ($82 000 to $125 000) in 2017. Kidney organ procurement costs contributed to 36% of mean OACC costs per transplantation throughout the study period. During the study period, transplantation hospitals experienced increases in kidney waiting list volume, kidney waiting list active volume, kidney transplantation volume, and comorbidity burden. For a median-sized transplantation program, mean OACC costs per transplantation decreased with more transplants (−$3500 [95% CI, −$4300 to −$2700] per 10 transplants; P < .001) and increased with year ($4400 [95% CI, $3500 to $5300] per year; P < .001), local price index ($1900 [95% CI, $200 to $3700] per 10-point increase; P = .03), patients listed active on the waiting list ($3100 [95% CI, $1700 to $4600] per 100 patients; P < .001), and patients on the waiting list with high comorbidities ($1500 [9% CI, $600 to $2500] per 1% increase in proportion of waitlisted patients with the highest comorbidity score; P = .002). CONCLUSIONS AND RELEVANCE: In this study, OACC costs increased at 4% per year from 2012 to 2017 and were not solely attributable to the cost of organ procurement. Expanding the waiting list will likely contribute to further increases in the mean OACC costs per transplantation and substantially increase Medicare liability. |
format | Online Article Text |
id | pubmed-8914579 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-89145792022-03-25 Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017 Cheng, Xingxing S. Han, Jialin Braggs-Gresham, Jennifer L. Held, Philip J. Busque, Stephan Roberts, John P. Tan, Jane C. Scandling, John D. Chertow, Glenn M. Dor, Avi JAMA Netw Open Original Investigation IMPORTANCE: While recent policy reforms aim to improve access to kidney transplantation for patients with end-stage kidney disease, the cost implications of kidney waiting list expansion are not well understood. The Organ Acquisition Cost Center (OACC) is the mechanism by which Medicare reimburses kidney transplantation programs, at cost, for costs attributable to kidney transplantation evaluation and waiting list management, but these costs have not been well described to date. OBJECTIVES: To describe temporal trends in mean OACC costs per kidney transplantation and to identify factors most associated with cost. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation included all kidney transplantation waiting list candidates and recipients in the United States from 2012 to 2017. A population-based study of cost center reports was conducted using data from all Center of Medicare & Medicaid–certified transplantation hospitals. Data analysis was conducted from June to August 2021. EXPOSURES: Year, local price index, transplantation and waiting list volume of transplantation program, and comorbidity burden. MAIN OUTCOMES AND MEASURES: Mean OACC costs per kidney transplantation. RESULTS: In 1335 hospital-years from 2012 through 2017, Medicare’s share of OACC costs increased from $0.95 billion in 2012 to $1.32 billion in 2017 (3.7% of total Medicare End-Stage Renal Disease program expenditure). Median (IQR) OACC costs per transplantation increased from $81 000 ($66 000 to $103 000) in 2012 to $100 000 ($82 000 to $125 000) in 2017. Kidney organ procurement costs contributed to 36% of mean OACC costs per transplantation throughout the study period. During the study period, transplantation hospitals experienced increases in kidney waiting list volume, kidney waiting list active volume, kidney transplantation volume, and comorbidity burden. For a median-sized transplantation program, mean OACC costs per transplantation decreased with more transplants (−$3500 [95% CI, −$4300 to −$2700] per 10 transplants; P < .001) and increased with year ($4400 [95% CI, $3500 to $5300] per year; P < .001), local price index ($1900 [95% CI, $200 to $3700] per 10-point increase; P = .03), patients listed active on the waiting list ($3100 [95% CI, $1700 to $4600] per 100 patients; P < .001), and patients on the waiting list with high comorbidities ($1500 [9% CI, $600 to $2500] per 1% increase in proportion of waitlisted patients with the highest comorbidity score; P = .002). CONCLUSIONS AND RELEVANCE: In this study, OACC costs increased at 4% per year from 2012 to 2017 and were not solely attributable to the cost of organ procurement. Expanding the waiting list will likely contribute to further increases in the mean OACC costs per transplantation and substantially increase Medicare liability. American Medical Association 2022-03-10 /pmc/articles/PMC8914579/ /pubmed/35267033 http://dx.doi.org/10.1001/jamanetworkopen.2022.1847 Text en Copyright 2022 Cheng XS et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Cheng, Xingxing S. Han, Jialin Braggs-Gresham, Jennifer L. Held, Philip J. Busque, Stephan Roberts, John P. Tan, Jane C. Scandling, John D. Chertow, Glenn M. Dor, Avi Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017 |
title | Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017 |
title_full | Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017 |
title_fullStr | Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017 |
title_full_unstemmed | Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017 |
title_short | Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017 |
title_sort | trends in cost attributable to kidney transplantation evaluation and waiting list management in the united states, 2012-2017 |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914579/ https://www.ncbi.nlm.nih.gov/pubmed/35267033 http://dx.doi.org/10.1001/jamanetworkopen.2022.1847 |
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