HEART-TRANSPLANTATION CHARGES - STATUS-1 VERSUS STATUS-2 PATIENTS

Background: The current health care environment mandates closer scruti ny of health care dollar allocation. To better understand the distribu tion of heart transplantation costs, we reviewed hospital and physicia n billing of patients who underwent orthotopic heart transplantation b etween August 1988 and September 1993. Methods: This study is a retros pective review of 107 consecutive cases. Charges and clinical results of United Network for Organ Sharing status 1 patients (n = 46), includ ing 17 bridge to transplantation patients, were compared with those of United Network for Organ Sharing status 2 patients (n = 57). Charges were converted to 1992 dollars. Results: During the first 12 months of the study, 77% of heart transplantations were performed in United Net work for Organ Sharing status 2 patients, whereas over the last 12-mon th period, 25% of the transplantations were performed in status 2 pati ents. No significant differences were found in age, gender, type of ca rdiomyopathy, or survival between the status 1 and status 2 groups. Th e length of hospitalization for the status 1 group ranged from 8 to 13 8 days (mean 49 days) as opposed to 5 to 82 days (mean 17.5 days) for the status 2 group (p < 0.0001). Pretransplantation hospital charges w ere significantly higher for the status 1 group ($47,917 to $341,215, mean $109,116) when compared with status 2 ($0 to $10,035, mean $250) (p < 0.0001). No significant difference was found in posttransplantati on hospital charges between status 1 ($47,917 to $210,027, mean $95,37 9) and status 2 patients ($48,093 to $380,745, mean $102,265). Total c harges were significantly higher (p < 0.0001) for the status 1 group ( $89,910 to $512,331, mean $239,375) when compared with the status 2 gr oup ($63,885 to $455,680, mean $128,594). Total transplantation charge s for the study period were $18,341,108. This amount could have paid f or 77 status 1 transplantations or 143 status 2 transplantations. Conc lusions: If current trends continue and the donor pool remains the sam e, most transplant recipients will be status 1, resulting in a compara ble number of transplantations performed at twice the charges.