The shrinking renal replacement therapy 'break-even' point

Eugene J. Schweitzer, Anne Wiland, Debora Evans, Melvin Novak, Ingrid Connerny, Lisa Norris, John O. Colonna, Benjamin Philosophe, Alan C. Farney, Bruce E. Jarrell, Stephen T. Bartlett

Research output: Contribution to journalArticle

Abstract

Background. This study examines the current cost of live donor (LD) transplantation at our institution, and compares it with that of dialysis. Methods. The study population consisted of 184 consecutive adult recipients of laparoscopically procured LD kidney transplants. Cost-containment measures instituted during this series included elimination of routine postoperative antilymphocyte induction and an accelerated discharge clinical pathway with planned discharge of the recipient on postoperative day (POD) 2. Costs of the transplants to Medicare were estimated from hospital charges, readmission rates, and immunosuppressant usage. These were compared with published costs of dialysis to Medicare in terms of a fiscal transplant-dialysis break-even point. Results. Kaplan-Meier patient and graft survival rates at 1 year were 97 and 93%, respectively. Among patients followed for at least 90 days and treated with no induction and either cyclosporine-mycophenolate mofetil or tacrolimus-mycophenolate mofetil, acute rejection rates were low (27.6 and 13.9%, respectively). In the last 124 patients, 32.3% were discharged by POD 3 and 71.8% by POD 6, with corresponding mean transplant hospital charges (excluding organ acquisition) of $11,873 and $17,350, respectively. The 30- day readmission rate for patients discharged on the accelerated pathway by POD 3 was only 16%. The least expensive subgroup in the present study (30% of patients) was that of patients discharged by POD 6 and not readmitted during the first year; the break-even point with dialysis costs was calculated as 1.7 years after the transplant. Conclusions. The cost of LD transplants can be safely reduced by elimination of routine postoperative antilymphocyte immune induction and by an early discharge clinical pathway. Uncomplicated LD kidney transplants, meaning those with a short length of stay in the hospital after transplantation and no need for readmission within the first year, accrue savings over dialysis within 2 years.

Original languageEnglish (US)
Pages (from-to)1702-1708
Number of pages7
JournalTransplantation
Volume66
Issue number12
DOIs
StatePublished - Dec 27 1998
Externally publishedYes

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Renal Replacement Therapy
Dialysis
Transplants
Costs and Cost Analysis
Tissue Donors
Mycophenolic Acid
Hospital Charges
Patient Readmission
Critical Pathways
Medicare
Transplantation
Kidney
Cost Control
Tacrolimus
Graft Survival
Immunosuppressive Agents
Cyclosporine
Length of Stay
Survival Rate
Population

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Schweitzer, E. J., Wiland, A., Evans, D., Novak, M., Connerny, I., Norris, L., ... Bartlett, S. T. (1998). The shrinking renal replacement therapy 'break-even' point. Transplantation, 66(12), 1702-1708. https://doi.org/10.1097/00007890-199812270-00023

The shrinking renal replacement therapy 'break-even' point. / Schweitzer, Eugene J.; Wiland, Anne; Evans, Debora; Novak, Melvin; Connerny, Ingrid; Norris, Lisa; Colonna, John O.; Philosophe, Benjamin; Farney, Alan C.; Jarrell, Bruce E.; Bartlett, Stephen T.

In: Transplantation, Vol. 66, No. 12, 27.12.1998, p. 1702-1708.

Research output: Contribution to journalArticle

Schweitzer, EJ, Wiland, A, Evans, D, Novak, M, Connerny, I, Norris, L, Colonna, JO, Philosophe, B, Farney, AC, Jarrell, BE & Bartlett, ST 1998, 'The shrinking renal replacement therapy 'break-even' point', Transplantation, vol. 66, no. 12, pp. 1702-1708. https://doi.org/10.1097/00007890-199812270-00023
Schweitzer EJ, Wiland A, Evans D, Novak M, Connerny I, Norris L et al. The shrinking renal replacement therapy 'break-even' point. Transplantation. 1998 Dec 27;66(12):1702-1708. https://doi.org/10.1097/00007890-199812270-00023
Schweitzer, Eugene J. ; Wiland, Anne ; Evans, Debora ; Novak, Melvin ; Connerny, Ingrid ; Norris, Lisa ; Colonna, John O. ; Philosophe, Benjamin ; Farney, Alan C. ; Jarrell, Bruce E. ; Bartlett, Stephen T. / The shrinking renal replacement therapy 'break-even' point. In: Transplantation. 1998 ; Vol. 66, No. 12. pp. 1702-1708.
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abstract = "Background. This study examines the current cost of live donor (LD) transplantation at our institution, and compares it with that of dialysis. Methods. The study population consisted of 184 consecutive adult recipients of laparoscopically procured LD kidney transplants. Cost-containment measures instituted during this series included elimination of routine postoperative antilymphocyte induction and an accelerated discharge clinical pathway with planned discharge of the recipient on postoperative day (POD) 2. Costs of the transplants to Medicare were estimated from hospital charges, readmission rates, and immunosuppressant usage. These were compared with published costs of dialysis to Medicare in terms of a fiscal transplant-dialysis break-even point. Results. Kaplan-Meier patient and graft survival rates at 1 year were 97 and 93{\%}, respectively. Among patients followed for at least 90 days and treated with no induction and either cyclosporine-mycophenolate mofetil or tacrolimus-mycophenolate mofetil, acute rejection rates were low (27.6 and 13.9{\%}, respectively). In the last 124 patients, 32.3{\%} were discharged by POD 3 and 71.8{\%} by POD 6, with corresponding mean transplant hospital charges (excluding organ acquisition) of $11,873 and $17,350, respectively. The 30- day readmission rate for patients discharged on the accelerated pathway by POD 3 was only 16{\%}. The least expensive subgroup in the present study (30{\%} of patients) was that of patients discharged by POD 6 and not readmitted during the first year; the break-even point with dialysis costs was calculated as 1.7 years after the transplant. Conclusions. The cost of LD transplants can be safely reduced by elimination of routine postoperative antilymphocyte immune induction and by an early discharge clinical pathway. Uncomplicated LD kidney transplants, meaning those with a short length of stay in the hospital after transplantation and no need for readmission within the first year, accrue savings over dialysis within 2 years.",
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AU - Schweitzer, Eugene J.

AU - Wiland, Anne

AU - Evans, Debora

AU - Novak, Melvin

AU - Connerny, Ingrid

AU - Norris, Lisa

AU - Colonna, John O.

AU - Philosophe, Benjamin

AU - Farney, Alan C.

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AU - Bartlett, Stephen T.

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N2 - Background. This study examines the current cost of live donor (LD) transplantation at our institution, and compares it with that of dialysis. Methods. The study population consisted of 184 consecutive adult recipients of laparoscopically procured LD kidney transplants. Cost-containment measures instituted during this series included elimination of routine postoperative antilymphocyte induction and an accelerated discharge clinical pathway with planned discharge of the recipient on postoperative day (POD) 2. Costs of the transplants to Medicare were estimated from hospital charges, readmission rates, and immunosuppressant usage. These were compared with published costs of dialysis to Medicare in terms of a fiscal transplant-dialysis break-even point. Results. Kaplan-Meier patient and graft survival rates at 1 year were 97 and 93%, respectively. Among patients followed for at least 90 days and treated with no induction and either cyclosporine-mycophenolate mofetil or tacrolimus-mycophenolate mofetil, acute rejection rates were low (27.6 and 13.9%, respectively). In the last 124 patients, 32.3% were discharged by POD 3 and 71.8% by POD 6, with corresponding mean transplant hospital charges (excluding organ acquisition) of $11,873 and $17,350, respectively. The 30- day readmission rate for patients discharged on the accelerated pathway by POD 3 was only 16%. The least expensive subgroup in the present study (30% of patients) was that of patients discharged by POD 6 and not readmitted during the first year; the break-even point with dialysis costs was calculated as 1.7 years after the transplant. Conclusions. The cost of LD transplants can be safely reduced by elimination of routine postoperative antilymphocyte immune induction and by an early discharge clinical pathway. Uncomplicated LD kidney transplants, meaning those with a short length of stay in the hospital after transplantation and no need for readmission within the first year, accrue savings over dialysis within 2 years.

AB - Background. This study examines the current cost of live donor (LD) transplantation at our institution, and compares it with that of dialysis. Methods. The study population consisted of 184 consecutive adult recipients of laparoscopically procured LD kidney transplants. Cost-containment measures instituted during this series included elimination of routine postoperative antilymphocyte induction and an accelerated discharge clinical pathway with planned discharge of the recipient on postoperative day (POD) 2. Costs of the transplants to Medicare were estimated from hospital charges, readmission rates, and immunosuppressant usage. These were compared with published costs of dialysis to Medicare in terms of a fiscal transplant-dialysis break-even point. Results. Kaplan-Meier patient and graft survival rates at 1 year were 97 and 93%, respectively. Among patients followed for at least 90 days and treated with no induction and either cyclosporine-mycophenolate mofetil or tacrolimus-mycophenolate mofetil, acute rejection rates were low (27.6 and 13.9%, respectively). In the last 124 patients, 32.3% were discharged by POD 3 and 71.8% by POD 6, with corresponding mean transplant hospital charges (excluding organ acquisition) of $11,873 and $17,350, respectively. The 30- day readmission rate for patients discharged on the accelerated pathway by POD 3 was only 16%. The least expensive subgroup in the present study (30% of patients) was that of patients discharged by POD 6 and not readmitted during the first year; the break-even point with dialysis costs was calculated as 1.7 years after the transplant. Conclusions. The cost of LD transplants can be safely reduced by elimination of routine postoperative antilymphocyte immune induction and by an early discharge clinical pathway. Uncomplicated LD kidney transplants, meaning those with a short length of stay in the hospital after transplantation and no need for readmission within the first year, accrue savings over dialysis within 2 years.

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