title: The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients.
abstract: Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29,267; regional sharing, 29,005; eight districts, 29,034; four districts, 28,265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638 million to $1506 million, p < 0.001), transplant episode ($5607 million to $5569 million, p < 0.03) and posttransplant care ($479 million to $488 million, p < 0.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11,874 per patient, p < 0.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Mathematics, United States Naval Academy, Baltimore, MD.|Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: S E
authors.initials: SE
authors.lastname: Gentry
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: E K H
authors.initials: EK
authors.lastname: Chow
authors.affiliation: St. Louis University Center for Outcomes Research, Saint Louis, MO.|Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: N
authors.initials: N
authors.lastname: Dzebisashvili
authors.affiliation: St. Louis University Center for Outcomes Research, Saint Louis, MO.
authors.forename: M A
authors.initials: MA
authors.lastname: Schnitzler
authors.affiliation: St. Louis University Center for Outcomes Research, Saint Louis, MO.
authors.forename: K L
authors.initials: KL
authors.lastname: Lentine
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: C E
authors.initials: CE
authors.lastname: Wickliffe
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: E
authors.initials: E
authors.lastname: Shteyn
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: J
authors.initials: J
authors.lastname: Pyke
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.|Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
authors.forename: A
authors.initials: A
authors.lastname: Israni
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
authors.forename: B
authors.initials: B
authors.lastname: Kasiske
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: D A
authors.initials: DA
authors.lastname: Axelrod
mesh_terms: D005102:Health Expenditures; D006801:Humans; D008107:Liver Diseases / Q000191:economics* / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D066027:Transplant Recipients; D014850:Waiting Lists
keywords: Sharing (UNOS); United Network for Organ; business; economics; ethics and public policy; health services and outcomes research; hepatology; liver disease; liver transplantation; management; organ allocation; organ procurement and allocation