*Purpose: Despite access to health insurance, financial concerns are among the most prevalent patient-reported barriers to kidney and liver transplantation (KT and LT, respectively). We sought to compare total costs and out of pocket (OOP) expenses in privately insured patients with advanced chronic kidney disease (CKD) or chronic liver disease (LD), compared to those of KT recipients (KTRs) or LT recipients (LTRs), respectively.

*Methods: Retrospective cohort analysis of adults with advanced CKD or chronic LD, or who underwent KT or LT based on ICD-9/ICD-10 or CPT codes between 1/1/2014-12/31/2018 using IBM MarketScan Commercial claims data. Patients were followed from index diagnosis or procedure to disenrollment or study end date. Cost of transplant procedure was included in annual total cost. OOP was defined as co-pays, deductibles, and coinsurance payments.

*Results: There were 3035 KTRs and 180,772 non-KTRs, and 922 LTRs vs 118,199 non-LTRs in the study period. KTRs were younger, more likely to be male, reside in an urban setting, and reside in states with early Medicaid expansion. Median annual total cost for KTRs was $95,821 [$55,242,$174,821] vs $18,560 [$7,284,$45,881] for non-KTRs. Median annual OOP cost was $2,848 [$1,786,$4,522] for KTRs vs $1,452 [$818,$2,436] for non-KTRs. LTRs were more likely to be female and reside in South or Central US vs non-LTRs. Median annual total medical cost for LTRs was $178,182 [$100,812,$293,706] vs $14,284 [$5,828,$38,356] for non-LTRs. Median annual OOP cost was $3,550 [$2,176,$5,346] for LTRs vs $1,529 [$808,$2,715] for non-LTRs

*Conclusions: In this study, KTRs and LTRs had 2-3 x higher median annual OOP expenses compared to non-transplant recipients. Contrary to our hypothesis and common belief, the median annual total cost for transplant recipients was higher than for non-recipients. Prior studies have shown a strong correlation between post-transplant financial hardship and poor transplant outcomes. Yet, financial education sessions required as part of the transplant selection process, are unstandardized and do not monitor patients’ comprehension. To improve patient outcomes, further research is needed on content and methods of financial education programs for patients awaiting transplantation.

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