Growing Kidney Transplant Waiting List Contributes to Rising Costs


Costs continue to rise related to kidney transplantation for patients with end-stage renal disease (ESKD), which may be related to concerted efforts to lengthen the kidney transplant waiting list in recent years.

A team, led by Xingxing S. Cheng, MD, MS, Division of Nephrology, Department of Medicine, Stanford University School of Medicine, described time trends in average organ acquisition costs (OACC) by kidney transplantation and identified the most important factors. associated with cost.

The Organ Procurement Cost Center

The OACC is the mechanism by which Medicare reimburses kidney transplant programs at cost to identify costs attributable to kidney transplant assessment and waiting list management.

In recent years, efforts have been made to improve access to kidney transplants for patients with end-stage renal disease. However, there has not been much research on the financial implications of lengthening the kidney donor waiting list. There is an estimated benefit of approximately $1.1 million for each kidney transplant using a cost-benefit analysis framework.

“Kidney transplantation is the treatment of choice for end-stage renal disease,” the authors write. “Because of the expense associated with the alternative (i.e. maintenance dialysis), kidney transplantation has often been hailed as a cost-effective treatment.”

Data analysis

In the Cost Center Reports population-based study, investigators analyzed data from all Center of Medicare & Medicaid-certified transplant hospitals and estimated costs for all applicants and recipients on the list. kidney transplant wait times in the United States between 2012 and 2017.

Investigators searched for the main results of OACC average costs per kidney transplant.

Overall, there were 1,335 years of hospitalization between 2012 and 2017 analyzed in the study. Medicare-related costs for OACC increased from $950 million in 2012 to $1.32 billion in 2017 (3.7% of total Medicare end-stage kidney disease program spending).

Additionally, median CABC costs per transplant increased from $81,000 ($66,000 to $103,000) in 2012 to $100,000 ($82,000 to $125,000) in 2017.

Transplant hospitals also recorded increases in kidney waiting list volume, active kidney waiting list volume, kidney transplant volume, and comorbidity burden.

Main findings

In the median-sized transplant program, mean OACC costs per transplant decreased with more transplants (-$3,500 for 10 transplants; 95% CI, -$4,300 to -$2,700; P P P P = .002).

“In this study, OACC costs increased by 4% per year from 2012 to 2017 and were not solely attributable to the cost of organ procurement,” the authors wrote. “Waiting longer will likely contribute to further increases in average OACC costs per transplant and significantly increase Medicare liability.”

The study, “Trends in Costs Attributable to Renal Transplant Assessment and Wait List Management in the United States, 2012-2017was published online in Open JAMA Network.


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