1. Cost Analysis of Liver Acquisition Fees Before and After Acuity Circle Policy Implementation
- Author
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Richard Ruiz, Nicholas Onaca, Robert M. Goldstein, Anji Wall, Hoylan Fernandez, Amar Gupta, Briget da Graca, Eric Martinez, Johanna Bayer, Gregory J. McKenna, James F. Trotter, Sumeet K. Asrani, and Giuliano Testa
- Subjects
Adult ,Male ,Organ procurement organization ,medicine.medical_specialty ,Tissue and Organ Procurement ,Waiting Lists ,End Stage Liver Disease ,Young Adult ,Liver disease ,Interquartile range ,Internal medicine ,Policy implementation ,medicine ,Humans ,business.industry ,Health Policy ,Patient Selection ,Significant difference ,Patient Acuity ,Middle Aged ,medicine.disease ,Transplantation ,Organ procurement ,Fees and Charges ,Costs and Cost Analysis ,Cost analysis ,Female ,Surgery ,business - Abstract
Importance Acuity circles (AC) liver allocation policy was implemented to eliminate donor service area geographic boundaries from liver allocation and to decrease variability in median Model of End-stage Liver Disease (MELD) score at transplant and wait list mortality. However, the broader sharing of organs was also associated with more flights for organ procurements and higher costs associated with the increase in flights. Objective To determine whether the costs associated with liver acquisition changed after the implementation of AC allocation. Design, Setting, and Participants This single-center cost comparison study analyzed fees associated with organ acquisition before and after AC allocation implementation. The cost data were collected from a single transplant institute with 2 liver transplant centers, located 30 miles apart, in different donation service areas. Cost, recipient, and transportation data for all cases that included fees associated with liver acquisition from July 1, 2019, to October 31, 2020, were collected. Exposures Primary liver offer acceptance with associated organ procurement organization or charter flight fees. Main Outcomes and Measures Specific fees (organ acquisition, surgeon, import, and charter flight fees) and total fees per donor were collected for all accepted liver donors with at least 1 associated fee during the study period. Results Of 213 included donors, 171 were used for transplant; 90 of 171 (52.6%) were male, and the median (interquartile range) age of donors was 41.0 (30.0-52.8) years in the pre-AC period and 36.9 (24.0-48.8) years in the post-AC period. There was no significant difference in the post-AC compared with pre-AC period in median (range) MELD score (24 [8-40] vs 25 [6-40]; P = .27) or median (range) match run sequence (15 [1-3951] vs 10 [1-1138]; P = .31), nor in mean (SD) distance traveled (155.83 [157.00] vs 140.54 [144.33] nautical miles; P = .32) or percentage of donors requiring flights (58.5% [69 of 118] vs 56.8% [54 of 95]; P = .82). However, costs increased significantly in the post-AC period: total cost increased 16% per accepted donor (mean [SD] of $52 966 [13 278] vs $45 725 [9300]; P
- Published
- 2021