Factors associated with the high cost of liver transplantation in adults.

OBJECTIVES To determine the overall direct cost of liver transplantation in Canadian adults and to identify the factors that are associated with high cost. METHODS The direct cost of liver transplantation from the perspective of third-party payers was determined in a retrospective analysis of data from hospital charts and databases. A consecutive series of 119 adults who underwent liver transplantation between 1991 and 1992 was followed from the date of listing for transplantation to the second anniversary of the transplant. Patient-specific services during the pre-transplantation, transplantation and post-transplantation phases were compiled and costed. The primary consideration was the impact of complications on the cost of transplantation. Secondary considerations were the impact of age, sex of the patient, diagnosis and severity of liver disease on the total cost. RESULTS The overall mean measured cost of liver transplantation was Can$89,066 (range from Can$30,505-Can$690,431). The multivariate logistic regression model for overall costs revealed that severe liver disease (OR = 11.97), cytomegalovirus infection (OR = 6.12), additional operative procedure (OR = 4.22) and biliary complications (OR = 5.00) were associated with an increased likelihood of high cost. The addition of services that were not measured in the present analysis increased the total overall cost to a mean of $121,732 (1998 Canadian dollars, follow-up costs discounted and inflation adjusted). INTERPRETATION The factors that were associated with high cost of liver transplantation in Canadian adults were advanced liver disease, postoperative cytomegalovirus infection, the requirement for additional operative procedures and biliary complications.

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