Trends in expenditures for medicare liver transplant recipients

Liver transplantation, a resource-intensive medical procedure, is under par ticular scrutiny in the current era of cost containment. There have been si gnificant changes in treatment protocols over the past decade; however, inf ormation is limited on how these changes have affected the economics of liv er transplantation. This study examines a time series from 1993 to 1999 in Medicare expenditures for liver transplantation. We estimated total first- and second-year expenditures, as well as expenditures 90 days pretransplant ation. These expenditures included inpatient, outpatient, physician, home h ealth, and hospice care; immunosuppression expenditures were not estimated. Average first-year expenditures (in year 2000 dollars) for liver transplan tation, excluding immunosuppressives, decreased from $201,677 in 1993 to $1 43,363 in 1998. Inpatient costs accounted for the majority of total expendi tures, decreasing from $179,306 in 1993 to $120,445 in 1998. Total days of hospitalization decreased from 56.7 days in 1993 to 42.2 days in 1998. The majority of hospitalization occurred during the first 90 days posttransplan tation, but decreased from 44.4 days in 1993 to 29.4 days in 1999. Substant ial cost reductions over this period were a result of reduced hospitalizati on and occurred while survival rates gradually improved.