title: High resource utilization in liver transplantation-how strongly differ costs between the care sectors and what are the main cost drivers?: a retrospective study.
abstract: To control treatment pathways of transplant patients across healthcare sectors, a profound knowledge of the underlying cost structure is necessary. The aim of this study was to analyze the resource utilization of patients undergoing liver transplantation. Data on resource utilization for 182 liver-transplanted patients was investigated retrospectively. The observational period started with the entry on the waiting list and ended up to 3 years after transplantation. Median treatment cost was 144 424€. During waiting time, median costs amounted to 9466€; 72% of costs were attributed to inpatient care, 3% to outpatient care, and 26% to pharmaceuticals. During the first year after transplantation, median costs of 105 566€ were calculated; 83% were allocated for inpatient and 1% outpatient care, 14% for drugs, and 1% for rehabilitative care. During follow-up after the first year of transplantation, median costs amounted to 20 115€; 75% of these were caused by pharmaceuticals, 21% by inpatient, 4% by outpatient, and <1% by rehabilitative services. Subgroup analyses (e.g., for labMELD scores) were done. Costs incurred by inpatient care and pharmaceuticals are the dominating cost factors. These findings encourage a debate on challenges and improvements for cost-efficient clinical management between different healthcare sectors.
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.|Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Lena
authors.identifier: http://orcid.org/0000-0003-3044-7906
authors.initials: L
authors.lastname: Harries
authors.affiliation: Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany.|Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
authors.forename: Jona T
authors.initials: JT
authors.lastname: Stahmeyer
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.|Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Krauth
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.|Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Volker E
authors.initials: VE
authors.lastname: Amelung
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D003365:Costs and Cost Analysis; D016527:Drug Costs; D005260:Female; D005858:Germany; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
keywords: German healthcare costs; cost analysis; cross-sectoral costs; liver transplantation economics; sectors of health care