[Cost analysis of liver transplantation in a community hospital: association with the Model for End-stage Liver Disease, a prognostic index to prioritize the most severe patients]. / Análisis del coste del trasplante hepático en un hospital de la comunidad: su relación con el Model for End-stage Liver Disease, un índice pronóstico que prioriza al paciente más grave.

INTRODUCTION: The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs. MATERIAL AND METHODS: We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40. RESULTS: The mean MELD score at transplantation was 19.2±7.0 (mean±SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493±8,825 in patients with a MELD score of 6-19 and was USD 36,506±15,833 in those with a score of 20-40; this difference was statistically significant (P=.04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r(2)=43%). DISCUSSION: Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD.

Análisis del coste del trasplante hepático en un hospital de la comunidad: su relación con el Model for End-stage Liver Disease, un índice pronóstico que prioriza al paciente más grave / Cost analysis of liver transplantation in a community hospital: association with the MODEL for End-stage Liver Disease, a prognostic index to prioritize the most severe patients

Introducción El objetivo del presente trabajo ha sido investigar el impacto del Model for End-stage Liver Disease(MELD) en los costes del trasplante. Material y métodos Se incluyeron todos los pacientes que recibieron un trasplante hepático por una enfermedad hepática terminal entre 2006 y 2010. El período de estudio incluye desde el día del trasplante hasta el alta hospitalaria. Los pacientes fueron categorizados en 2 grupos: 6 a 19 y 20 a 40. En forma arbitraria se definió como alto coste aquel que excedía el percentil 85. Se analizaron 77 pacientes. Resultados La media del puntaje MELD al momento del trasplante fue 19,2±7,0 (media ± DE). La media de los costes por trasplante en el período mencionado fue de 33.461 USD por paciente (rango 21.795-104.629). El coste del trasplante en los pacientes que tenían un valor de MELD de 6-19 fue de 30.493±8.825 USD y en aquellos con un MELD de 20-40, de 36.506±15.833 USD, siendo esta diferencia estadísticamente significativa (p=0,04). En un análisis escalonado por regresión logística, tener un puntaje MELD 20 fue el único predictor independiente de alto coste (OR 11,8; CI 1,6-87). En el modelo de regresión lineal, el tiempo de estancia hospitalaria fue el predictor más relevante de coste (r2=43%).Discusión Nuestros resultados demuestran que el MELD tiene un impacto directo en el coste del trasplante. Sugerimos que los sistemas de reembolso deberían compensar a los diferentes prestadores en relación a la gravedad de la patología de base, evaluada mediante el modelo MELD (AU)

Introduction The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs. Material and methods We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40.ResultsThe mean MELD score at transplantation was 19.2±7.0 (mean±SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493±8,825 in patients with a MELD score of 6-19 and was USD 36,506±15,833 in those with a score of 20-40; this difference was statistically significant (P=.04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r2=43%).Discussion Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD(AU)