Potential savings in the treatment pathway of liver transplantation: an inter-sectorial analysis of cost-rising factors

Lena Harries (), Jill Gwiasda, Zhi Qu, Harald Schrem, Christian Krauth and Volker Eric Amelung
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Lena Harries: Hannover Medical School
Jill Gwiasda: Hannover Medical School
Zhi Qu: Hannover Medical School
Harald Schrem: Hannover Medical School
Christian Krauth: Hannover Medical School
Volker Eric Amelung: Hannover Medical School

The European Journal of Health Economics, 2019, vol. 20, issue 2, No 10, 301 pages

Abstract: Abstract Introduction Identification of cost-driving factors in patients undergoing liver transplantation is essential to target reallocation of resources and potential savings. Aim The aim of this study is to identify main cost-driving factors in liver transplantation from the perspective of the Statutory Health Insurance. Methods Variables were analyzed with multivariable logistic regression to determine their influence on high cost cases (fourth quartile) in the outpatient, inpatient and rehabilitative healthcare sectors as well as for medications. Results Significant cost-driving factors for the inpatient sector of care were a high labMELD-score (OR 1.042), subsequent re-transplantations (OR 7.159) and patient mortality (OR 3.555). Expenditures for rehabilitative care were significantly higher in patients with a lower adjusted Charlson comorbidity index (OR 0.601). The indication of viral cirrhosis and hepatocellular carcinoma resulted in significantly higher costs for medications (OR 21.618 and 7.429). For all sectors of care and medications each waiting day had a significant impact on high treatment costs (OR 1.001). Overall, cost-driving factors resulted in higher median treatment costs of 211,435 €. Conclusions Treatment costs in liver transplantation were significantly influenced by identified factors. Long pre-transplant waiting times that increase overall treatment costs need to be alleviated by a substantial increase in donor organs to enable transplantation with lower labMELD-scores. Disease management programs, the implementation of a case management for vulnerable patients, medication plans and patient tracking in a transplant registry may enable cost savings, e.g., by the avoidance of otherwise necessary re-transplants or incorrect medication.

Keywords: High cost cases; Cost analysis of liver transplantation; Sectors of healthcare; Cross-sectorial costs; German healthcare costs (search for similar items in EconPapers)
JEL-codes: I10 (search for similar items in EconPapers)
Date: 2019
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Citations: View citations in EconPapers (1)

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DOI: 10.1007/s10198-018-0994-y

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