title: LabMELD-based organ allocation increases total costs of liver transplantation: a single-center experience.
abstract: BACKGROUND
  In 2006, model for end-stage liver disease (MELD)-based allocation was implemented in the Eurotransplant (ET) region. Sick patients, who in general require more resources, are prioritized. In this analysis, the effect of MELD on costs for liver transplantation (LTx) was assessed.
  
  
  METHODS
  Total costs for LTx before and after implementation of MELD were identified in 256 patients from January 2005-December 2007. Forty-nine patients (Re-LTx, HU listings, and 30-d mortality) were excluded from further analysis. The costs of LTx in 207 patients have been correlated with their corresponding labMELD; 84 and 123 LTx before and after implementation of MELD were compared, and patient survival was monitored.
  
  
  RESULTS
  A positive correlation exists between labMELD and costs (r(2) = 0.28; p < 0.05). Only nominal correlation existed between the Child-Pugh classification and costs. The labMELD scores can be stratified into four groups (I: 6-10, II: 11-18, III: 19-24, and IV: >24), with an increase of €15.672 ± 2.233 between each group (p < 0.05). Recipients' labMELD at the time of LTx increased significantly in the MELD-based allocation system. Costs increased by €11.650/patient (p < 0.05), while median survival decreased from 1219 to 869 d (p < 0.05).
  
  
  CONCLUSIONS
  LabMELD-based allocation increased total costs of LTx. In accordance with other studies, the sickest patients need the most resources.
authors.affiliation: Department for General and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Bruns
authors.forename: Norbert
authors.initials: N
authors.lastname: Hillebrand
authors.forename: Tobias
authors.initials: T
authors.lastname: Schneider
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Lars
authors.initials: L
authors.lastname: Fischer
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Andreas J W
authors.initials: AJ
authors.lastname: Goldschmidt
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D000293:Adolescent; D003362:Cost-Benefit Analysis; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016031:Liver Transplantation / Q000191:economics* / Q000401:mortality*; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications; D018570:Risk Assessment; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000191:economics*; D016896:Treatment Outcome