COST-EFFECTIVENESS ANALYSIS OF LIVER TRANSPLANTATION.
Contributors: University of Tennessee Center for the Health Sciences.
Published: 1996
Number of pages: 124
Subjects: Health Sciences, Nursing.; Health Sciences, Health Care Management.; Health Sciences, Medicine and Surgery.
Description: In an era of decreasing financial resources and increasing shortage of donor organs, maximizing cost-effective outcomes is imperative. This investigation was undertaken to determine the cost effectiveness of liver transplantation. Clinical and financial data were obtained from the charts of 102 adult patients who underwent liver transplantation since January, 1990, at The University of Tennessee William F. Bowld Hospital. Financial charges were adjusted by departmental cost-to-charge ratios and consumer price indices to obtain 1995 dollar equivalents for comparison. Costs for patients who had not survived to an evaluation point were equally distributed among survivors within strata to result in a summary measurement of cost per survival. Analysis of variance (ANOVA) was utilized to determine differences in cost per survival among classes of patients according to the UNOS (graded 1, 2, or 3 representing highest, moderate, and lowest acuity) and Child-Pugh (graded C or B representing highest and moderate acuity) pre-operative severity of illness classification systems.

Significant differences were noted in total cost of transplantation per survival between UNOS classes 1 and 2 and between classes 2 and 3 (p $\leq$ 0.0001) at three months, one year, and two year survival points. Similarly, significant differences were noted between Child-Pugh Classes C and B at one year (p = 0.0069) and two years (p = 0.0018). Multiple stepwise regression and path analysis were employed for model development. Models to predict total cost of transplantation per survival at three months and one year survival points incorporate UNOS score, necessity for a second liver during hospitalization, and reoperation (necessity for any additional surgical procedure) resulting in R$\sp2$ = 0.71 and 0.80, respectively. Additionally, UNOS score and reoperation were able to predict cost at two years survival (R$\sp2$ = 0.73).

By demonstrating differences in cost and mortality among differing pre-operative acuities, this study supports the proposition for changing organ allocation priority from those of highest acuity to a lower acuity. Additionally, this study validates the ability of the UNOS score to predict cost per survival.
Notes: Source: Dissertation Abstracts International, Volume: 57-10, Section: B, page: 6174.

Thesis (PH.D.)--THE UNIVERSITY OF TENNESSEE CENTER FOR THE HEALTH SCIENCES, 1996.

School code: 0783.