title: The economic implications of noninvasive molecular testing for cardiac allograft rejection.
abstract: Endomyocardial biopsy is the mainstay for monitoring cardiac allograft rejection. A noninvasive strategy--peripheral blood gene expression profiling of circulating leukocytes--is an alternative with proven benefits, but unclear economic implications. Financial data were obtained from five cardiac transplant centers. An economic evaluation was conducted to compare the costs of outpatient biopsy with those of a noninvasive approach to monitoring cardiac allograft rejection. Hospital outpatient biopsy costs averaged 3297 US dollars, excluding reimbursement for professional fees. Costs to Medicare and private payers averaged 3581 US dollars and 4140 US dollars, respectively. A noninvasive monitoring test can reduce biopsy utilization. The savings to health care payers in the United States can be conservatively estimated at approximately 12.0 million US dollars annually. Molecular testing using gene expression profiling of peripheral circulating leukocytes is a new technology that offers physicians a noninvasive, less expensive alternative to endomyocardial biopsy for monitoring allograft rejection in cardiac transplant patients.
authors.affiliation: Evans.Roger@Charter.net
authors.forename: Roger W
authors.initials: RW
authors.lastname: Evans
authors.forename: Gavin E
authors.initials: GE
authors.lastname: Williams
authors.forename: Helen M
authors.initials: HM
authors.lastname: Baron
authors.forename: Mario C
authors.initials: MC
authors.lastname: Deng
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Eisen
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Hunt
authors.forename: Mahmud M
authors.initials: MM
authors.lastname: Khan
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
authors.forename: Eric N
authors.initials: EN
authors.lastname: Marton
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Seema R
authors.initials: SR
authors.lastname: Mital
mesh_terms: D001706:Biopsy / Q000191:economics; D003365:Costs and Cost Analysis; D020869:Gene Expression Profiling; D006084:Graft Rejection / Q000191:economics*; D016027:Heart Transplantation / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000191:economics*; D010820:Physicians / Q000191:economics; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D014184:Transplantation, Homologous