Factors Associated With Rehospitalization and High Cost Among Health Plan Members Receiving Kidney Transplants
1Astellas Scientific and Medical Affairs, Northbrook, IL
2Comprehensive Health Insights, Humana, Louisville, KY.
Meeting: 2015 American Transplant Congress
Abstract number: A238
Keywords: Kidney transplantation
Session Information
Session Name: Poster Session A: Non Organ Specific, Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Purpose
Aims were to develop a claims-based algorithm to identify kidney transplant cases and to examine clinical and economic outcomes among health plan members undergoing kidney transplantation.
Methods
This study was a retrospective analysis of administrative claims data from a large managed care organization. Kidney transplant cases were identified using a claims-based algorithm consisting of ICD-9-CM, CPT, and DRG codes associated with medical claims from Jan 1 2007 to Dec 31 2012. Patient and plan characteristics were measured during a 12-month period preceding the index transplant hospitalization. Outcomes including transplant-related length of stay (TR-LOS), rehospitalization (RH), and healthcare costs were measured during a 12-month period after the index hospitalization. Factors associated with RH and high cost (defined as the top tertile of cases by total post-transplant cost) were identified.
Results
A total of 745 kidney transplant cases were identified using the claims-based algorithm. Of these cases, 98.4% (n=733) were validated against internal health plan transplant data. After applying continuous enrollment criteria, 316 members were included in the analysis. Kidney transplant members were primarily male (58.2%, n=184) and mean (SD) age was 58.5 (12.7) years. Mean (SD) length of stay for the transplant hospitalization was 8.6 (5.6) days. Twelve-month all-cause RH was observed for 67.7% (n=214) of members. Mean (SD) number of RHs was 2.3 (4.2) overall. In bivariate analyses, higher Elixhauser score (P=0.004), longer TR-LOS (P=0.004), graft failure (P<0.001), and retransplantation (P<0.001) were associated with RH. The most commonly observed diagnosis associated with RH were complication of transplanted kidney (n = 92, 43.0%), acute renal failure (n=47, 22.0%), and fever (n=41, 19.2%). Median pre-transplant, transplant admission, and post-discharge healthcare costs were $63,595, $58,166, and $46,535, respectively. In bivariate analysis, younger age (P=0.039), higher Elixhauser score (P=0.001), longer TR-LOS (P<0.001), RH (P<0.001), graft failure (P<0.001), and retransplantation (P<0.001) were associated with high costs.
Conclusion
Administrative claims data may be useful for health plans to identify kidney transplantation cases, measure health-related outcomes including RH and healthcare costs, and identify potential drivers of cost.
To cite this abstract in AMA style:
Lee E, Zhou Y, Suehs B, Franks B, Kassman B, Spalding J, Thal G. Factors Associated With Rehospitalization and High Cost Among Health Plan Members Receiving Kidney Transplants [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/factors-associated-with-rehospitalization-and-high-cost-among-health-plan-members-receiving-kidney-transplants/. Accessed May 17, 2025.« Back to 2015 American Transplant Congress