Sociodemographic Predictors of Inpatient Costs for Solid Organ Transplants
Raymond A. Jean, *Alexander S. Chiu, Peter S. Yoo
Yale School of Medicine, New Haven, CT
Objective: To identify predictors associated with increased costs for liver(LT) and kidney(KT) transplants.
Design: Retrospective cohort
Setting: Patients admitted across the United States between 2005 and 2014.
Patients: The Nationwide Inpatient Sample (NIS) was examined for adult patients receiving LT or KT.
Main Outcome Measures: We used multivariable linear models identify the effect of insurance and clinical predictors, on hospital costs.
Results: There were 155,608 (76.5%) KT and 47,673 (23.5%) LT selected during the study period. Mean hospital costs were ,222 (± ) for KT and ,768 (± ) for LT. Factors predictive for increased cost in KT included increased comorbidity (one + ± 663 and two or more +,916 ± 1258; both p<0.0001), Medicaid (+ ± 1385 vs private; p<0.0001) or Medicare (+ ± 542 vs private; p=0.004), region in the Midwest ( ± 2447; p=0.0003) or West (+ ± 2157; p=0.004), and hospital bed size (medium +,403 ± 2120 and large ,778 ± 1744; both p<0.0001). In contrast, predictors for increased cost in LT included female sex (+ ± 2121; p=0.002), Medicaid (+,098 ± 3167; p=0.0001) or Medicare (+ ± 2546; p=0.002).
Conclusions: For patients receiving LT or KT Medicare and Medicaid insurance, and care outside in regions other than the South, were associated with increased hospital costs. These results indicate that across abdominal transplant types, costs are consistently associated with non-clinical and hospital factors, potentially relating to delivery patterns and social determinants of health.