Background: Liver transplantation is a complex and costly procedure that is the only definitive treatment for irreversible liver disease. Given that transplant admission costs account for more than half of peri-transplant expenditures, examining whether hospitals drive costs independent of patient characteristics and complications may inform efforts to provide more cost-effective care.

Methods: We collected demographic and billing data of 1,883 adult liver transplant recipients across US transplant centers from the 2012 and 2013 National Inpatient Sample, and identified comorbidities, reasons for liver transplant, complications and total hospital charges. Hospital costs were estimated by multiplying inflation-adjusted charges with hospital-specific cost-to-charge ratios and inverse wage indexes. Estimated costs were log-transformed to achieve normal distribution, and multilevel linear regression analyses with varying intercepts by transplant center were performed. A sensitivity analysis of 275 patients who had a length of stay of less than six days, had no complications and survived the transplant hospitalization was performed.

Results: The mean total hospital charges and estimated costs were $473,062 and $124,595 respectively. Of 207 hospital billing units, 24 had significantly higher costs than average and 24 had significantly lower costs than average, even after adjusting for complications, comorbidities, reasons for liver transplant and region. This cost variation persisted on sensitivity analysis for patients with brief lengths of stay and no complications, where of 107 billing units, 5 had significantly higher costs than average and 11 had significantly lower costs than average. The strongest patient-level drivers of cost were repeat liver transplant during the same hospitalization, sepsis, pneumonia, wound disruption and stroke.

Conclusions: Significant cost variation exists among liver transplant centers even after adjusting for measurable patient characteristics and complications. More granular comparisons of high-cost and low-cost hospitals may inform efforts to provide more cost-effective care.

CITATION INFORMATION: Santos C, Hota B, Hertl M. Unexplained Cost Variation for Liver Transplantation: A National Study of US Transplant Centers. Am J Transplant. 2017;17 (suppl 3).

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