Introduction: While previous studies have evaluated risk factors, management, and outcomes in patients who develop biliary strictures (BS) after undergoing orthotopic liver transplantation (OLT), none have specifically assessed the financial burden of this complication. The objective of this study was to approximate hospital costs associated with BS and determine where costs were incurred.

Methods: The Premier Perspective^® Hospital Database was queried for patients undergoing OLT between 2010 and 2016. Patients who did and did not develop BS were compared with respect to demographic, peri-operative, and outcome variables. Multivariable regression models were used to estimate the differences between the two patient groups.

Results: Of a 2938 patients undergoing OLT, 85 (2.9%) developed BS. There were no significant differences between the BS and no BS groups with respect to patient age or gender. There were no differences noted between the two groups with respect to operating room time or 30 day readmission, though development of BS was associated with a higher likelihood of in-hospital mortality (odds ratio=3.01, 95% confidence interval = 1.37-6.58, p=0.006). Patients who developed BS had a significantly longer length of stay (35.3 days vs. 17.8 days, p<0.001) and were more likely to be discharged to a destination other than home with or without home health (p=0.03). Development of a post-transplant BS was associated with an incremental cost increase of $81811 (45.8%, p<0.001). The greatest relative increases were noted in radiology (+163.5%, p<0.001) and respiratory therapy (+157.1%, p<0.001) costs, while the greatest absolute increase was noted in room and board cost (+$27589, p<0.001). Laboratory, pharmacy, physical/occupational/speech therapy, and supply costs were approximately double in patients with BS compared to those with no BS (all p<0.001).

Conclusions: The increased cost associated with BS after OLT derives from multiple factors, particularly higher room and board due to longer LOS and increased need for inpatient therapies and tests. In addition to incentivizing measures that may prevent BS, insurers should factor in these requirements for more resource-intensive care among patients who develop BS when developing payment schemes for OLT.

CITATION INFORMATION: Jones J., Bhutiani N., Wei D., Goldstein L., Martin R., Jones C., Cannon R. Cost Analysis of Biliary Strictures Following Orthotopic Liver Transplantation in the United States Am J Transplant. 2017;17 (suppl 3).

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