Changes in pediatric heart transplant hospitalization costs over time

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Abstract

Background

Despite significant changes in the past decade for children undergoing heart-transplantation, including the evolution of mechanical circulatory support and increasing patient complexity, costs and resource utilization have not been reassessed. We sought to utilize a novel linkage of clinical-registry and administrative data to examine changes in hospitalization costs over time in this population.

Methods

We identified all pediatric heart transplant recipients in a unique linked PHIS/SRTR dataset (2002-2016). Hospital costs were estimated from charges using cost-to-charge ratios, inflated to 2016 dollars. Severity-adjusted costs were calculated using generalized linear mixed-effects models. Costs were compared across 3 eras (Era-1:2002-2006; Era-2:2007-2011; and Era-3:2012-2016).

Results

A total of 2896 pediatric heart transplant recipients were included; Era-1:649 (22.4%), Era-2:1028 (35.5%), and Era-3:1219 (42.1%). ECMO support at transplant decreased over time, concurrent with an increase in VAD-supported patients. Between Era-1 and Era-2 there was an increase in pretransplant hospitalization costs ($343,692 vs. $435,554; p<0.001). However, between Era-2 and Era-3 there was a decline in total ($906,454 vs. $767,221; p<0.001), pretransplant ($435,554 vs. $353,364; p<0.001), and posttransplant ($586,133 vs. $508,719; p=0.002) hospitalization costs.

Conclusions

Concurrent with the increase in utilization of VAD support, there has been an increase in pretransplant costs associated with pediatric heart transplantation. However, in the most recent era, costs have declined. These findings suggest the evolution of more cost-effective management strategies, which may be related to shifts in the approach to pediatric mechanical circulatory support.

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