Understanding Inpatient Cost Variation in Kidney Transplantation: Implications for Payment Reforms

Chandy Ellimoottil, Zaojun Ye, Apurba K. Chakrabarti, Michael J. Englesbe, David C. Miller, John T. Wei, Amit Mathur

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective To examine the magnitude and sources of inpatient cost variation for kidney transplantation. Methods We used the 2005-2009 Nationwide Inpatient Sample to identify patients who underwent kidney transplantation. We first calculated the patient-level cost of each transplantation admission and then aggregated costs to the hospital level. We fit hierarchical linear regression models to identify sources of cost variation and to estimate how much unexplained variation remained after adjusting for case-mix variables commonly found in administrative datasets. Results We identified 8866 living donor (LDRT) and 5589 deceased donor (DDRT) renal transplantations. We found that higher costs were associated with the presence of complications (LDRT, 14%; P <.001; DDRT, 24%; P <.001), plasmapheresis (LDRT, 27%; P <.001; DDRT, 27%; P <.001), dialysis (LDRT, 4%; P <.001), and prolonged length of stay (LDRT, 84%; P <.001; DDRT, 82%; P <.001). Even after case-mix adjustment, a considerable amount of unexplained cost variation remained between transplant centers (DDRT, 52%; LDRT, 66%). Conclusion Although significant inpatient cost variation is present across transplant centers, much of the cost variation for kidney transplantation is not explained by commonly used risk-adjustment variables in administrative datasets. These findings suggest that although there is an opportunity to achieve savings through payment reforms for kidney transplantation, policymakers should seek alternative sources of information (eg, clinical registry data) to delineate sources of warranted and unwarranted cost variation.

Original languageEnglish (US)
Pages (from-to)88-94
Number of pages7
JournalUrology
Volume87
DOIs
StatePublished - Jan 1 2016

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Kidney Transplantation
Inpatients
Costs and Cost Analysis
Risk Adjustment
Linear Models
Transplants
Plasmapheresis
Hospital Costs
Living Donors
Diagnosis-Related Groups
Registries
Dialysis
Length of Stay
Transplantation
Tissue Donors

ASJC Scopus subject areas

  • Urology

Cite this

Ellimoottil, C., Ye, Z., Chakrabarti, A. K., Englesbe, M. J., Miller, D. C., Wei, J. T., & Mathur, A. (2016). Understanding Inpatient Cost Variation in Kidney Transplantation: Implications for Payment Reforms. Urology, 87, 88-94. https://doi.org/10.1016/j.urology.2015.05.037

Understanding Inpatient Cost Variation in Kidney Transplantation : Implications for Payment Reforms. / Ellimoottil, Chandy; Ye, Zaojun; Chakrabarti, Apurba K.; Englesbe, Michael J.; Miller, David C.; Wei, John T.; Mathur, Amit.

In: Urology, Vol. 87, 01.01.2016, p. 88-94.

Research output: Contribution to journalArticle

Ellimoottil C, Ye Z, Chakrabarti AK, Englesbe MJ, Miller DC, Wei JT et al. Understanding Inpatient Cost Variation in Kidney Transplantation: Implications for Payment Reforms. Urology. 2016 Jan 1;87:88-94. https://doi.org/10.1016/j.urology.2015.05.037
Ellimoottil, Chandy ; Ye, Zaojun ; Chakrabarti, Apurba K. ; Englesbe, Michael J. ; Miller, David C. ; Wei, John T. ; Mathur, Amit. / Understanding Inpatient Cost Variation in Kidney Transplantation : Implications for Payment Reforms. In: Urology. 2016 ; Vol. 87. pp. 88-94.
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AB - Objective To examine the magnitude and sources of inpatient cost variation for kidney transplantation. Methods We used the 2005-2009 Nationwide Inpatient Sample to identify patients who underwent kidney transplantation. We first calculated the patient-level cost of each transplantation admission and then aggregated costs to the hospital level. We fit hierarchical linear regression models to identify sources of cost variation and to estimate how much unexplained variation remained after adjusting for case-mix variables commonly found in administrative datasets. Results We identified 8866 living donor (LDRT) and 5589 deceased donor (DDRT) renal transplantations. We found that higher costs were associated with the presence of complications (LDRT, 14%; P <.001; DDRT, 24%; P <.001), plasmapheresis (LDRT, 27%; P <.001; DDRT, 27%; P <.001), dialysis (LDRT, 4%; P <.001), and prolonged length of stay (LDRT, 84%; P <.001; DDRT, 82%; P <.001). Even after case-mix adjustment, a considerable amount of unexplained cost variation remained between transplant centers (DDRT, 52%; LDRT, 66%). Conclusion Although significant inpatient cost variation is present across transplant centers, much of the cost variation for kidney transplantation is not explained by commonly used risk-adjustment variables in administrative datasets. These findings suggest that although there is an opportunity to achieve savings through payment reforms for kidney transplantation, policymakers should seek alternative sources of information (eg, clinical registry data) to delineate sources of warranted and unwarranted cost variation.

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