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Gentry SE, Chow EKH, Dzebisashvili N, Schnitzler MA, Lentine KL, Wickliffe CE, Shteyn E, Pyke J, Israni A, Kasiske B, Segev DL, Axelrod DA. The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients. Am J Transplant 2016; 16:583-93. [PMID: 26779694 DOI: 10.1111/ajt.13569] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/27/2015] [Accepted: 09/04/2015] [Indexed: 01/25/2023]
Abstract
Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29,267; regional sharing, 29,005; eight districts, 29,034; four districts, 28,265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638 million to $1506 million, p < 0.001), transplant episode ($5607 million to $5569 million, p < 0.03) and posttransplant care ($479 million to $488 million, p < 0.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11,874 per patient, p < 0.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.
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Affiliation(s)
- S E Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Mathematics, United States Naval Academy, Baltimore, MD.,Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - E K H Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - N Dzebisashvili
- St. Louis University Center for Outcomes Research, Saint Louis, MO.,Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - M A Schnitzler
- St. Louis University Center for Outcomes Research, Saint Louis, MO
| | - K L Lentine
- St. Louis University Center for Outcomes Research, Saint Louis, MO
| | - C E Wickliffe
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E Shteyn
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - J Pyke
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - A Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - B Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - D L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - D A Axelrod
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Massie AB, Chow EKH, Wickliffe CE, Luo X, Gentry SE, Mulligan DC, Segev DL. Early changes in liver distribution following implementation of Share 35. Am J Transplant 2015; 15:659-67. [PMID: 25693474 PMCID: PMC6116537 DOI: 10.1111/ajt.13099] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 01/25/2023]
Abstract
In June 2013, a change to the liver waitlist priority algorithm was implemented. Under Share 35, regional candidates with MELD ≥ 35 receive higher priority than local candidates with MELD < 35. We compared liver distribution and mortality in the first 12 months of Share 35 to an equivalent time period before. Under Share 35, new listings with MELD ≥ 35 increased slightly from 752 (9.2% of listings) to 820 (9.7%, p = 0.3), but the proportion of deceased-donor liver transplants (DDLTs) allocated to recipients with MELD ≥ 35 increased from 23.1% to 30.1% (p < 0.001). The proportion of regional shares increased from 18.9% to 30.4% (p < 0.001). Sharing of exports was less clustered among a handful of centers (Gini coefficient decreased from 0.49 to 0.34), but there was no evidence of change in CIT (p = 0.8). Total adult DDLT volume increased from 4133 to 4369, and adjusted odds of discard decreased by 14% (p = 0.03). Waitlist mortality decreased by 30% among patients with baseline MELD > 30 (SHR = 0.70, p < 0.001) with no change for patients with lower baseline MELD (p = 0.9). Posttransplant length-of-stay (p = 0.2) and posttransplant mortality (p = 0.9) remained unchanged. In the first 12 months, Share 35 was associated with more transplants, fewer discards, and lower waitlist mortality, but not at the expense of CIT or early posttransplant outcomes.
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Affiliation(s)
- A B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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