Regional disparities in liver transplantation motivated revision of national organ-sharing policies towards critically ill patients. Liver transplantation of high MELD patients incorporates significant institutional commitment to patients whom will not always meet transplant criteria. Data was collected from admissions to an advanced liver disease service at an 885-bed tertiary hospital who received liver transplantation or medical care. Cost-benefit analyses were performed on 422 admissions with a diagnosis of end stage liver disease from July 2013 to June 2014. 31 ICD-9-CM codes identified patients with advanced liver disease. The average length of stay for non-transplanted patients (N=335) was 7.8 days, and the total combined (pre and post) length of stay) for transplanted patients (N=87) was 23.3 days. 30-day readmission rate was 29%. Total reimbursement rates of 100% and 87% for transplanted and non-transplanted patients, respectively, were reported. Significant net revenue from both transplanted ($16.5M) and non-transplanted ($8.5M) was reported. Considering the direct variable expenses, the contribution margins of $7.3M and $4.0M were reported for transplanted and non-transplanted patients, respectively. After deducting the direct fixed expenses from contribution margins, the total direct margins of $4.5M for transplanted patients and $2.0M for non-transplanted patients were reported. Findings support the financial sustainability of expanding care for patients with advanced liver disease. Liver failure patients with high MELD scores require substantial resources. Nonetheless, these data demonstrate a positive financial contribution of advanced liver disease patients regardless of whether they received liver transplantation.

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