Liver Transpl. 2023 Dec 18. doi: 10.1097/LVT.0000000000000320. Online ahead of print.
ABSTRACT
BACKGROUND: Liver transplantation (LT) is lifesaving for patients with cirrhosis; however, resultant financial burden to patients has not been well characterized. We aimed to provide a nationally representative portrayal of patient financial burden after LT.
METHODS: Adult LT recipients from 2006-2021 were identified using IQVIA PharMetrics® Plus for Academics-a large nationally representative claims database of commercially insured Americans. Patient financial liability (i.e., what patients owe) was estimated using the difference of allowed and paid costs for adjudicated medical/pharmacy claims. Descriptive statistics were provided stratified by financial liability group within 1-year post-LT. Multivariable logistic regression modeling identified factors associated with high/extreme liability adjusting for covariates. Potential indirect costs of post-LT care were estimated based on hourly wages lost for care.
RESULTS: Among 1,412 LT recipients, financial liability was heterogeneous-~3% had no liability and 21% had extreme liability>$10K for 1-year post-LT care; most (69%) paid between $1-10K, with 48% having liability>$5K. Factors associated with>$5K liability included older age, insurance/enrollment type, U.S. region, history of hepatocellular carcinoma, and simultaneous liver-kidney transplant (for liability>$10K). Medication costs comprised ~30% outpatient financial liability. Potential indirect costs from wages lost was $2,201-$6,073 per person depending on hourly wage.
CONCLUSION: In a large national cohort of commercially insured LT recipients, financial liability was highly variable across sociodemographic and clinical characteristics; nearly 1 out 2 LT recipients owed>$5K for 1 year of post-LT care. Transplant programs should help patients anticipate potential costs and identify vulnerable populations who would benefit from enhanced financial counseling.
PMID:38108824 | DOI:10.1097/LVT.0000000000000320
