We have located links that may give you full text access.
Identifying drivers of cost in pediatric Liver Transplantation.
Liver Transplantation 2024 March 28
BACKGROUND & AIMS: Understanding the economics of pediatric liver transplantation (LT) is central to high-value care initiatives. We examined cost and resource utilization in pediatric LT nationally to identify drivers of cost and hospital factors associated with greater total cost of care.
APPROACH & RESULTS: We reviewed 3295 children (<21 y) receiving a LT from 2010-2020 in the Pediatric Health Information System to study cost, both per LT and service-line, and associated mortality, complications and resource utilization. To facilitate comparisons, patients were stratified into high-, intermediate-, or low-cost tertiles based on LT cost. The median cost per LT was $150,836 [IQR $104,481-250,129], with marked variance in cost within, and between, hospital tertiles. High-cost hospitals (HCH) cared for more patients with the highest severity of illness, and mortality risk levels (67% and 29%, respectively), compared to intermediate (60%, 21%; p<0.001), and low (51%,16%; p<0.001) cost hospitals. Patients at HCH experienced a higher prevalence of mechanical ventilation, TPN use, renal comorbidities and surgical complications than other tertiles. Clinical (27.5%), Laboratory (15.1%), and Pharmacy (11.9%) service-lines contributed most to total cost. Renal comorbidities ($69,563) and TPN use ($33,192) were large, independent contributors to total cost, irrespective of the cost tertile (p<0.001).
CONCLUSIONS: There exists significant variation in pediatric LT cost, with HCH caring for more patients with higher illness acuity and resource need. Studies are needed to examine drivers of cost and associated outcomes more granularly, with the goal of defining value and standardizing care. Such efforts may uniquely benefit the sicker patients requiring the strategic resources located within HCH to achieve the best outcomes.
APPROACH & RESULTS: We reviewed 3295 children (<21 y) receiving a LT from 2010-2020 in the Pediatric Health Information System to study cost, both per LT and service-line, and associated mortality, complications and resource utilization. To facilitate comparisons, patients were stratified into high-, intermediate-, or low-cost tertiles based on LT cost. The median cost per LT was $150,836 [IQR $104,481-250,129], with marked variance in cost within, and between, hospital tertiles. High-cost hospitals (HCH) cared for more patients with the highest severity of illness, and mortality risk levels (67% and 29%, respectively), compared to intermediate (60%, 21%; p<0.001), and low (51%,16%; p<0.001) cost hospitals. Patients at HCH experienced a higher prevalence of mechanical ventilation, TPN use, renal comorbidities and surgical complications than other tertiles. Clinical (27.5%), Laboratory (15.1%), and Pharmacy (11.9%) service-lines contributed most to total cost. Renal comorbidities ($69,563) and TPN use ($33,192) were large, independent contributors to total cost, irrespective of the cost tertile (p<0.001).
CONCLUSIONS: There exists significant variation in pediatric LT cost, with HCH caring for more patients with higher illness acuity and resource need. Studies are needed to examine drivers of cost and associated outcomes more granularly, with the goal of defining value and standardizing care. Such efforts may uniquely benefit the sicker patients requiring the strategic resources located within HCH to achieve the best outcomes.
Full text links
Related Resources
Trending Papers
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities.Diabetologia 2024 April 17
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Eosinophilic Esophagitis: Clinical Pearls for Primary Care Providers and Gastroenterologists.Mayo Clinic Proceedings 2024 April
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app