Bigger pies, bigger slices: Increased hospitalization costs for lung transplantation recipients in the non-donation service area allocation era.
Bigger pies, bigger slices: Increased hospitalization costs for lung transplantation recipients in the non-donation service area allocation era.
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蛋糕越大，切片越大：非捐献服务区分配时代肺移植受者的住院费用增加。
DOI：
10.1016/j.jtcvs.2024.01.045
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Bush,ErrolL
中科院分区：
文献类型：
--
作者：
Kalra,Andrew;Ruck,JessicaM;Zhou,AliceL;Akbar,ArmaanF;Shou,BenjaminL;Casillan,AlfredJ;Ha,JinnyS;Merlo,ChristianA;Bush,ErrolL
【摘要】目的2017年11月24日，肺移植分配由捐献服务区改为半径250海里政策，以提高肺移植获得的公平性。考虑到医疗费用的日益增加，我们评估了这一政策变化后住院费用的变化。方法对2005 - 2020年全国住院患者样本进行肺移植住院调查。接受者被分为捐赠服务区时代（2015年8月~ 2017年10月）和非捐赠服务区时代（2017年12月~ 2020年2月）。总住院费用中位数（经通货膨胀调整）按年代进行全国和地区比较。采用多变量广义线性回归来确定捐赠服务区的移除是否与总住院费用相关。根据受者人口统计学、Charlson合并症指数、住院地区、移植类型（单、双）、体外膜氧合、体外肺灌注和机械通气的使用情况对模型进行调整。结果分析12985例肺移植受者（中位年龄61岁，66%为男性）：捐献服务区时代7070例，非捐献服务区时代5915例。在这两个时代，接受者的人口结构并没有什么不同。非捐赠服务区时代受者体外膜氧合使用、机械通气（< 24小时）和住院时间均高于捐赠服务区时代受者。非捐赠服务区与捐赠服务区受助者的住院总费用中位数增加了24,198美元(157,964美元对182,162美元，百分比变化= 15.32%，P<。001)。东北中部地区（42,281美元）和山区（35,521美元）的中位数成本均有所增加(P<。01)。调整后，非捐赠服务区与捐赠服务区受助者的中位数成本仍然增加（19,168美元，95% CI, 145-38,191， P=）。048)。结论2015 - 2020年肺移植住院费用呈上升趋势。从基于捐赠服务区的分配向非捐赠服务区系统的过渡可能是2017年之后这一增长的原因，因为病情较重的受者获得移植的机会增加了。
Abstract Objective On November 24, 2017, lung transplant allocation switched from donation service area to a 250–nautical mile radius policy to improve equity in access to lung transplantation. Given the growing consideration of healthcare costs, we evaluated changes in hospitalization costs after this policy change. Methods Lung transplant hospitalizations were identified within the National Inpatient Sample from 2005 to 2020. Recipients were categorized as donation service area era (August 2015 to October 2017) or non–donation service area era (December 2017 to February 2020). Median total hospitalization costs (inflation adjusted) were compared by era nationally and regionally. Multivariable generalized linear regression was performed to determine if the removal of the donation service area was associated with total hospitalization costs. The model was adjusted for recipient demographics, Charlson Comorbidity Index, hospitalization region, transplant type (single, double), and use of extracorporeal membrane oxygenation, ex vivo lung perfusion, and mechanical ventilation. Results We analyzed 12,985 lung transplant recipients (median age of 61 years, 66% were male): 7070 in the donation service area era and 5915 in the non–donation service area era. Demographics were not different between recipients in both eras. Non–donation service area era recipients had greater extracorporeal membrane oxygenation use, mechanical ventilation (< 24 hours), and longer length of stay than donation service area era recipients. Median total hospitalization costs for non–donation service area versus donation service area era recipients increased by $24,198 ($157,964 vs $182,162, percentage change= 15.32%, P<. 001). Median costs increased in East North Central ($42,281) and Mountain ($35,521) regions (both P<. 01). After adjustment, median costs for non–donation service area versus donation service area era recipients still increased ($19,168, 95% CI, 145-38,191, P=. 048). Conclusions Hospitalization costs for lung transplant hospitalizations have increased from 2015 to 2020. The transition from donation service area–based allocation to the non–donation service area system may have contributed to this increase after 2017 by increasing access to transplant for sicker recipients.
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