Jill E. Martin

Economic cost of expanded criteria donors in cadaveric renal transplantation: Analysis of medicare payments.

Background. The use of expanded criteria donors (ECDs) in cadaveric renal transplantation is increasing in the US.We assess the economic impact of the use of ECDs to the Medicare end stage renal disease program. Methods. The United Nations for Organ Sharing renal transplant registry was merged to Medicare claims data for 42,868 cadaveric renal transplants performed between 1991–1996 using USRDS identifiers. Only recipients for whom Medicare was the primary payer were considered, leaving 34,534 transplants. An ECD was defined as (1) age ≤5 or ≥55 years, (2) nonheart-beating donors, donor history of (3) hypertension or (4) diabetes. High-risk recipients (HRR) were age >60 years, or a retransplant. Medicare payments from the pretransplant dialysis period were projected forward to provide a financial “breakeven point” with transplantation. Results. There were 25,600 non-HRR transplants, with 5,718 (22%) using ECDs, and 8,934 HRR transplants, of which 2,200 (25%) used ECDs. The 5-year present value of payments for non-ECD/non-HRR donor/recipient pairings was

The influence of clinical variables on hospital costs after orthotopic liver transplantation

121,698 vs.

Laparoscopic donor nephrectomy vs. open live donor nephrectomy: a quality of life and functional study

143,329 for ECD/non-HRR pairings (P <0.0001) and, similarly was

The evaluation of the safety and tolerability of two formulations of cyclosporine: neoral and sandimmune. A meta-analysis.

134,185 for non-ECD/HRR pairings vs.

Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study

165,716 for ECD/HRR pairings (P <0.0001). The break even point with hemodialysis ranged from 4.4 years for non-ECD/non-HRR pairings to 13 years for the ECD/HRR combinations but was sensitive to small changes in graft survival. Transplantation was always less expensive than hemodialysis in the long run. Conclusions. The impact of ECDs on Medicare payments is most pronounced in high-risk recipients. Cadaveric renal transplantation is a cost-saving treatment strategy for the Medicare ESRD program regardless of recipient risk status or the use of ECDs.

The Clinical and Economic Potential of Cyclosporin Drug Interactions

BACKGROUND The burgeoning influence of managed care in transplantation, coupled with a shrinking health-care dollar, has placed most transplant programs under intense pressure to cut costs. We undertook a retrospective cost-identification analysis to determine what clinical variables influenced financial outcomes after orthotopic cadaver liver transplants (OLTx). METHODS Fifty patients receiving 53 transplants between April 1995 and November 1996 were reviewed. Clinical data were obtained from our institutions transplant database, and total costs (not charges) for the transplant admission and the 6 months after transplant were obtained with use of an activity-based cost accounting system (HBOC Trendstar, Atlanta, Ga). RESULTS The average total cost of second transplants (n = 5) was

Incidence of adverse events with HMG‐CoA reductase inhibitors in liver transplant patients

97,262 greater than for first transplants (n = 48, P < .05). Patients transplanted initially as United Network for Organ Sharing (UNOS) status 2 (n = 20) incurred average costs that were

Warfarin Resistance and Enteral Feedings

51,762 higher than for patients transplanted as UNOS status 3 (n = 28, P = .008). Patients with a major bacterial or fungal infection (n = 28) incurred average costs

The expanding role of the transplant pharmacist in the multidisciplinary practice of transplantation

46,282 higher than recipients who were infection free (n = 22, P = .02). Multivariate analysis demonstrated that only length of stay, retransplantation, and postoperative dialysis were significantly and independently correlated with costs (r2 = .605). When the model was repeated with preoperative variables alone, only UNOS status was significantly correlated with 6-month total costs (P = .006, r2 = .16). CONCLUSIONS Length of stay is the most important determinant of costs after OLTx. Rational strategies to design cost-effective protocols after OLTx will require further studies to truly define the cost of various morbidities and outcomes after OLTx.

Evaluation of the safety and tolerability of neoral and sandimmune: a meta-analysis

Abstract:  Background:  Few studies have compared the quality of life (QoL) and functional recuperation of laproscopic donor nephrectomy (LDN) vs. open donor nephrectomy (ODN) donors. This study utilized the SF‐36 health survey, single‐item health‐related quality of life (HRQOL) score, and a functional assessment questionnaire (‘Donor Survey’).