Resource utilization in liver transplantation - Effects of patient characteristics and clinical practice

Context Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources util ized for this procedure and specific patient characteristics and clinical p ractices. Objective To assess the association of pretransplant patient characteristic s and clinical practices with hospital resource utilization. Design Prospective cohort of patients who received liver transplants betwee n January 1991 and July 1994. Setting University of California, San Francisco; Mayo Clinic, Rochester, Mi nn; and the University of Nebraska, Omaha, Patients Seven hundred eleven patients who received single-organ liver tran splants, were at least 16 years old, and had nonfulminant liver disease. Main Outcome Measure Standardized resource utilization derived from a datab ase created by matching all services to a single price list. Results Higher adjusted resource utilization was associated with donor age of 60 years or older (28% [$53 813] greater mean resource utilization; P=.0 05); recipient age of 60 years or older (17% [$32 795]; P=.01); alcoholic l iver disease (26% [$49 596]; P=.002); Child-Pugh class C (41% [$67 658]; P< .001); care from the intensive care unit at time of transplant (42% [$77 83 3]; P<.001); death in the hospital (35% [$67 076]; P<.001); and having mult iple liver transplants during the index hospitalization (154% increase [$47 4 740 vs $186 726 for 1 transplant]; P<.001). Adjusted length of stay and r esource utilization also differed significantly among transplant centers. Conclusions Clinical, economic, and ethical dilemmas in liver transplantati on are highlighted by these findings. Recipients who were older, had alcoho lic liver disease, or were severely ill were the most expensive to treat; t his suggests that organ allocation criteria may affect transplant costs. Cl inical practices and resource utilization varied considerably among transpl ant centers; methods to reduce variation in practice patterns, such as clin ical guidelines, might lower costs while maintaining quality of care.