AN ECONOMIC-ANALYSIS OF PANCREAS TRANSPLANTATION - COSTS, INSURANCE-COVERAGE, AND REIMBURSEMENT

Since 1988 the demand for the pancreas transplantation has continued t o increase. This has been accompanied by a growth in the number of cen ters offering the procedure, and an increase in the number of transpla nts performed. The National Cooperative Transplantation Study was unde rtaken to document the costs of all transplants, including pancreas tr ansplantation. Data on transplantation procedure charges, from date of transplant to discharge, were obtained from 66.7% of all pancreas tra nsplantation programs active in 1988. These programs accounted for 72% of all transplants performed that year. Valid sample survey data (no more than 25 transplants per center) were obtained for 133 randomly se lected patients. This constituted 54% of all procedures done in the Un ited States in 1988. Detailed data were also collected on sources of p ayment and amount reimbursed. Due to outlier data, we report statistic al medians, rather than means, as our measure of central tendency. The median charge for a pancreas transplant with or without a kidney was $66 917, with a hospital length of stay of 21 days, compared with a ki dney transplant alone at $39 625 and a hospital length of stay of 14 d ays. Total pancreas transplant charges fell between $45 260 and $105 3 75 for 50% of the cases studied. Half of the patients had a hospital l ength of stay between 16 and 33 days. Due to the small number of cases available for analysis, it was not meaningful to cross-classify the d ata according to various prognostic variables. Fifty percent of the tr ansplants studied were paid for by private insurers, and reimbursement exceeded 80% of billed charges for 50.6% of the cases analyzed. Insur ance reimbursement for pancreas transplantation is not uniform, but is favorable for those covered. While the number of procedures performed annually has increased since 1980, with the largest increases occurri ng since 1988, sustained growth may well be a function of insurance co verage. Many transplant centers are unable to bear the expense of panc reas transplants insurers fail to cover. As a result, access will be a problem for some patients.