PAYER STATUS, BUT NOT RACE, AFFECTS THE COST OF LIVER-TRANSPLANTATION

Prior studies evaluating the impact of race and payer on cost of liver transplantation did not adjust for clinical factors known to increase cost. We analyzed the impact of race and payer on the cost of liver t ransplantation after controlling for clinical factors. We analyzed dat a obtained on patient and graft survival, cost, race, age, sex, payer, and United Network for Organ Sharing (UNOS) status from 153 consecuti ve liver transplants in 130 patients performed at University of North Carolina Hospitals from September 1991 through December 1996. Race was classified as white or nonwhite, and payer status was classified as c ommercial or Medicare/Medicaid. Multivariate linear regression was use d to compare costs, adjusting for age, sex, race, payer, and UNOS stat us. For the 130 patients, 1-year patient and graft survival rates were 88% and 82%, respectively. There were no significant differences in p atient and graft survival or in the unadjusted average cost of liver t ransplantation by race or payer. After adjusting for demographic and c linical factors, the cost of transplantation was $28,494 more for Medi care/Medicaid recipients compared with the commercial insurance recipi ents (P = .02). The Medicare/Medicaid group had higher intensive care unit costs compared with the commercial insurance group ($17,807 and $ 9,359, respectively; P = .03), and a longer length of stay (41 and 31 days, respectively; P = .04). There was no significant difference in c ost between whites and nonwhites adjusting for these factors. Medicare or Medicaid patients had a higher cost of transplantation compared wi th those with commercial insurance. The cost of liver transplantation was similar for whites and nonwhites. Copyright (C) 1998 by the Americ an Association for the Study of Liver Diseases.