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

Author

Listed:
  • Lena Harries

    (Hannover Medical School
    Hannover Medical School)

  • Jill Gwiasda

    (Hannover Medical School)

  • Zhi Qu

    (Hannover Medical School
    Hannover Medical School)

  • Harald Schrem

    (Hannover Medical School
    Hannover Medical School)

  • Christian Krauth

    (Hannover Medical School
    Hannover Medical School)

  • Volker Eric Amelung

    (Hannover Medical School
    Hannover Medical School)

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.

Suggested Citation

  • Lena Harries & Jill Gwiasda & Zhi Qu & Harald Schrem & Christian Krauth & Volker Eric Amelung, 2019. "Potential savings in the treatment pathway of liver transplantation: an inter-sectorial analysis of cost-rising factors," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 281-301, March.
    • Handle: RePEc:spr:eujhec:v:20:y:2019:i:2:d:10.1007_s10198-018-0994-y
    DOI: 10.1007/s10198-018-0994-y
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    References listed on IDEAS

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    1. Mary Charlson & Martin T Wells & Ralph Ullman & Fionnuala King & Celia Shmukler, 2014. "The Charlson Comorbidity Index Can Be Used Prospectively to Identify Patients Who Will Incur High Future Costs," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-16, December.
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    Cited by:

    1. Manuel Melo Mateus & Margarida Catalão-Lopes & Rui Portugal, 2023. "Survival analysis of cancer patients in Portugal following the reference centre model implementation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(2), pages 157-168, March.

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    More about this item

    Keywords

    High cost cases; Cost analysis of liver transplantation; Sectors of healthcare; Cross-sectorial costs; German healthcare costs;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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