title: Variation in Cost and Quality in Kidney Transplantation.
abstract: BACKGROUND
  Bending the cost curve in medical expenses is a high national priority. The relationship between cost and kidney allograft failure has not been fully investigated in the United States.
  
  
  METHODS
  Using Medicare claims from the United States Renal Data System, we determined costs for all adults with Medicare coverage who underwent kidney transplant January 1, 2007, to June 30, 2009. We compared relative cost (observed/expected payment) for year 1 after transplantation for all transplant centers, adjusting for recipient, donor, and transplant characteristics, region, and local wage index. Using program-specific reports from the Scientific Registry of Transplant Recipients, we correlated relative cost with observed/expected allograft failure between centers, excluding small centers.
  
  
  RESULTS
  Among 19,603 transplants at 166 centers, mean observed cost per patient per center was $65,366 (interquartile range, $55,094-$71,624). Mean relative cost was 0.99 (± 0.20); mean observed/expected allograft failure was 1.03 (± 0.46). Overall, there was no correlation between relative cost and observed/expected allograft failure (r = 0.096, P = 0.22). Comparing centers with higher than expected costs and allograft failure rates (lower performing) and centers with lower than expected costs and failure rates (higher-performing) showed differences in donor and recipient characteristics. As these characteristics were accounted for in the adjusted cost and allograft failure models, they are unlikely to explain the differences between higher- and lower-performing centers.
  
  
  CONCLUSIONS
  Further investigations are needed to determine specific cost-effective practices of higher- and lower-performing centers to reduce costs and incidence of allograft failure.
authors.affiliation: 1 Department of Medicine, Hennepin County Medical Center, Minneapolis, MN. 2 Department of Medicine, University of Minnesota, Minneapolis, MN. 3 Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN. 4 Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN. 5 Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO. 6 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. 7 Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bishara A
authors.initials: BA
authors.lastname: Nassir
authors.forename: Carl E
authors.initials: CE
authors.lastname: Dean
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Nicholas
authors.initials: N
authors.lastname: Salkowski
authors.forename: Craig A
authors.initials: CA
authors.lastname: Solid
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts / Q000191:economics; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D017048:Health Care Costs; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics* / Q000379:methods*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012042:Registries; D051437:Renal Insufficiency / Q000191:economics* / Q000601:surgery*; D014481:United States