1 economics
kidney ............................. pancreas ......................... liver ................................ intestine .......................... heart ............................... lung ................................
4 7 10 13 16 20
M. A. Schnitzler1,2 , M. A. Skeans1 , D. A. Axelrod3 , K. L. Lentine2 , J. E. Tuttle-Newhall4 , J. J. Snyder1,5 , A. K. Israni1,5,6 , B. L. Kasiske1,6
1
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
2
Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
3
Section of Transplant Surgery, DartmouthHitchcock Medical Center, Lebanon, NH
4
Division of Abdominal Transplant, Saint Louis University School of Medicine, St. Louis, MO
5
Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
6
Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
OPTN/SRTR 2013 Annual Data Report:
Economics
ABSTRACT While the costs to Medicare of solid organ transplant are varied and considerable, the total Medicare expenditure of $4.4 billion for solid organ transplant recipients was less than 1% of all Medicare expenditures in 2012. Kidney transplant remains one of the most cost-effective surgical interventions in medicine. Heart transplant, the most expensive of the major transplants, is likely cost-effective; SRTR has released an Excel-based tool for investigators to use in exploring this question further. It is likely that most solid organ transplants are cost-effective, given the results presented here and the relatively high cost of heart transplant. However, this must be verified with further study.
KEY WORDS Costs and cost analysis, cost-benefit analysis, health expenditures, Medicare.
I still find it so amazing that you were generous enough to give someone you don't even know such a gift. Going through this has shown me that there is still a lot of good in the world.
Keith, heart recipient
2
OPTN/SRTR 2013 Annual Data Report
KIDNEY Kidney transplant is among the most cost-effective procedures in medicine because of the great expense of dialysis as an alternative treatment and the consequences of no treatment. However, kidney transplant is not without considerable direct economic cost. From transplant through 1 year after transplant, the average reimbursement for kidney recipients with primary Medicare coverage was $63 thousand for Part A and $20 thousand for Part B (Figure Econ 1.4). Rehospitalization is a primary driver of interpatient variation in the cost of care. Rehospitalization rates are relatively high in the first year after transplant, with an average of 130 hospitalizations per 100 patient-years at risk, dropping to 59 in the second year (Figure Econ 1.2). The primary causes of rehospitalization are dominated by surgical complications and infections in both the first and second years after transplant (Figure Econ 1.3). The cost of care in the second year is approximately one-third of first-year cost, at $14 thousand for Part A and $10 thousand for Part B (Figure Econ 1.5). The total Part A and Part B Medicare expenditure on kidney transplant recipients was $2.6 billion in 2010 and increased to $2.8 billion in 2012 (Figure Econ 1.6), accounting for 63% of all Medicare expenditures on solid organ transplant recipients in 2012. Patients with diabetes as the cause of kidney failure were the highest expenditure group ($0.9 billion in Parts A and B expenditures in 2012), followed by those with endstage renal disease from hypertension ($0.6 billion in Parts A and B expenditures in 2012) (Figure Econ 1.6).
PANCREAS The average Medicare expenditure for pancreas recipients from the time of transplant through 1 year after transplant was $97 thousand for Part A and $25 thousand for Part B in 2012 (Figure Econ 2.4). These estimates are similar to Medicare's costs for diabetic recipients of a kidney transplant: $70 thousand for Part A and $22 thousand for Part B (Figure Econ 1.4). Pancreas recipients are rehospitalized much less frequently than kidney recipients (Figures Econ 2.2 and
Econ 1.2). This may reflect differences in the underlying disease, type of surgery, and possible complications, as well as differences in patient selection and use of higher-quality organs. The total Medicare expenditure for pancreas recipients in 2012 was $224 million, representing 5% of all Medicare expenditures on solid organ transplant recipients (Figure Econ 2.6).
LIVER Medicare coverage of liver transplant increased from 30% of recipients in 2008 to more than 36% in 2012, and, while many of these patients are of retirement age, a sizable proportion of younger patients were covered by Medicare (Figure Econ 3.1). The average reimbursement for liver recipients with primary Medicare coverage from transplant through 1 year after transplant was $163 thousand and $26 thousand for Part B in 2012 (Figure Econ 3.4), totaling to $189 thousand, which is more than twice the average Medicare expenditure for a kidney transplant recipient (Figure Econ 1.4). However, the long-term costs of care, represented here by cost in the second year after transplant, are similar in liver ($29 thousand) and kidney ($25 thousand) recipients (Figures Econ 3.5 and Econ 1.5, respectively). The total Medicare expenditure on liver recipients in 2012 was $669 million (Figure Econ 3.6), 15% of all Medicare expenditures for solid organ transplant recipients.
INTESTINE Considered at the patient level, Medicare coverage of intestine transplant recipients is proportionally the smallest of all solid organ transplant recipients, at 16% in 2012 (Figure Econ 4.1). However, intestine transplant is the most expensive solid organ transplant reimbursed by Medicare, with average first-year costs of $344 thousand for Part A and $43 thousand for Part B (Figure Econ 4.4), totaling to $387 thousand. The high cost of intestine transplant may in part be a consequence of the high rate of multi-organ transplant with intestine transplant, seen in 48% of Medicare-covered recipients in
3 economics
2008-2011. Because of the small number of procedures, the total Medicare expenditure on intestine transplant recipients in 2012 was $11 million (Figure Econ 4.5), which is less than 1% of all Medicare expenditures on solid organ transplant recipients.
LUNG Medicare paid for some or all of the care for 56% of lung transplant recipients in 2012 (Figure Econ 6.1), the highest percentage among all solid organ transplants other than kidney and pancreas. More than 30% of lung recipients aged 18 to 34 years were covered by Medicare (Figure Econ 6.1). The average Medicare reimbursement from transplant through 1 year after transplant was $208 thousand for Part A and $28 thousand for Part B (Figure Econ 6.4), which is similar to the cost of care for liver transplant recipients but approaches 3 times the cost of care for kidney transplant patients. Rehospitalization is more common after lung transplant than after any other solid organ transplant except intestine transplant. Consequently, second-year average total costs after lung transplant are the highest, at $39 thousand for Part A and $13 thousand for Part B, totaling to $52 thousand (Figure Econ 6.5). However, because of the small total number of lung transplants covered by Medicare, the total Medicare expenditure on lung transplant recipients was relatively small, at $285 million (Figure Econ 6.6), 6% of all Medicare expenditures on solid organ transplant recipients.
HEART Medicare was the largest single payer for heart transplant in the United States, with more than 42% of recipients covered by Medicare in 2012, and, similar to lung transplant, nearly 20% of heart recipients aged 18 to 34 years covered by Medicare (Econ 5.1). The average Medicare reimbursement from transplant through 1 year after transplant was $266 thousand for Part A and $35 thousand for Part B (Figure Econ 5.4), totaling to $301 thousand, representing the second highest average total costs, after intestine transplant. First-year Medicare expenditures for heart transplant recipients were more than 1.5 times greater than the Medicare expenditures for liver transplant recipients and 3 to 4 times those for kidney transplant recipients (Figures Econ 3.4 and Econ 1.4, respectively). However, second-year Medicare costs after heart transplant were closer to second-year costs in liver than in lung transplant, at $22 thousand for Part A and $14 thousand for Part B, totaling to $36 thousand (Figure Econ 6.5). The total Medicare expenditure on heart transplant recipients in 2012 was $450 million, 10% of all Medicare expenditures on solid organ transplant recipients (Figure Econ 5.6).
Heart Cost-Effectiveness
Beginning with this Annual Data Report (ADR), SRTR is releasing multivariate cost estimates suitable for use in costeffectiveness modeling in solid organ transplantation. Heart transplant is the first transplant type addressed; future ADRs will address other solid organ transplant types. Multivariate predictors of cost associated with heart transplant were estimated using robust regression with the Mestimator, because of the presence of influential outliers in the data (Figure Econ 5.8). These estimates facilitate detailed cost analysis that may be applied in the setting of a clinical trial, policy analysis, or comparisons of costs for cohorts of heart transplant recipients. Variable definitions follow exactly from the patient survival equations used in the SRTR heart transplant program-specific reports. Markov modeling techniques can be applied to estimate expected cost and survival after heart transplant. For example, these techniques were applied in a comparison of patients who underwent transplant after they had had a ventricular assist device (VAD) procedure and those who underwent transplant without ever having had a VAD procedure. The VAD was associated with markedly higher costs and lower survival. The total expected discounted cost of care from 1 year before transplant through 20 years after transplant was $505 thousand for a patient with a VAD and $525 thousand for one without a VAD. However, 20-year survival with a VAD is expected to be 17% with 5.53 discounted qualityadjusted life years (QALYs), compared with 26% and 6.28 discounted QALYs without a VAD. Combining cost and effect through 20 years after transplant, patients with a VAD cost $91 thousand per QALY compared with $84 thousand per QALY for those without a VAD. In either case, cost per QALY is generally less than the $100 thousand per QALY generally observed in maintenance dialysis, a common costeffectiveness reference treatment intervention. An Excel-based tool to perform the calculations presented here and other economic calculations in heart transplant is available at www.srtr.org/Exceltools/ SRTRADR2013_HeartEcon.xlsx. This simple example assumes that the characteristics of patients who underwent transplant after receiving a VAD and those without a VAD were otherwise this same. This may or may not be a reasonable assumption; investigators are invited to download the tool and make their own comparisons. This tool could be used for a number of economic analyses in heart transplantation, including comparisons of alternative mechanical treatment strategies, new pharmaceutical interventions, competing allocation policies, and other important questions in solid organ transplantation.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
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OPTN/SRTR 2013 Annual Data Report
kidney
Econ 1.2 Rehospitalization rates among kidney transplant recipients in years 1 and 2 posttransplant Econ 1.1 Medicare coverage among kidney transplant recipients, 20082012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other infection Other Gastro-intestinal Metabolic, endocrine, nutritional Urinary tract infection Genito-urinary and breast Bacteremia, viremia and septicemia Electrolyte, acid-base and volume depletion Respiratory infection
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year 2 rates on rehospitalizations in the subsequent year.
% 33.2 9.8 8.4 6.2 4.9 4.8 4.1 4.1 3.9 3.3
Year 2 Cause of hospitalization Surgical complications Other infection Other Gastro-intestinal Metabolic, endocrine, nutritional Bacteremia, viremia and septicemia Urinary tract infection Respiratory infection Genito-urinary and breast Skin and musculoskeletal
% 21.4 9.4 8.4 7.4 7.2 5.9 5.7 5.1 4.7 3.0
Econ 1.3 Top ten causes of rehospitalization among kidney transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
5 economics
kidney Total costs ($ in thousands) Part A Part B 2,308,834 722,373
PPPY costs ($) Part A Part B 63,369 19,827
All recipients
N 38,238
Age
0-11 12-17 18-34 35-49 50-64 65+
432 577 4,828 10,406 14,049 7,946
38,273 39,784 271,722 596,815 866,639 495,600
8,239 10,312 93,238 199,255 261,945 149,383
90,662 71,336 58,237 59,673 64,949 66,575
19,517 18,491 19,983 19,923 19,631 20,067
Sex
Male Female
23,311 14,927
1,401,067 907,766
437,222 285,150
63,054 63,862
19,677 20,061
Race
White Black Hispanic Asian Other/unknown
17,965 11,823 5,875 1,993 582
1,080,074 759,730 326,790 109,254 32,986
327,749 236,502 114,491 34,080 9,551
63,131 67,803 57,844 57,061 59,215
19,157 21,107 20,266 17,799 17,145
Primary diagnosis
Diabetes Hypertension GN CKD Other
11,256 10,133 6,396 3,819 6,634
746,070 579,339 333,850 210,048 439,527
233,281 189,602 110,584 65,530 123,376
70,330 60,023 54,139 56,915 69,571
21,991 19,644 17,933 17,756 19,529
Econ 1.4 Total and per person per year Medicare costs of kidney transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after a transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
All recipients
N 25,693
Total costs ($ in thousands) Part A Part B 354,841 261,391
PPPY costs ($) Part A Part B 14,149 10,423
Age
0-11 12-17 18-34 35-49 50-64 65+
315 408 3,362 7,110 9,346 5,152
5,715 9,214 43,732 85,272 133,024 77,885
3,080 3,939 34,841 72,774 92,874 53,884
18,453 23,167 13,341 12,244 14,597 15,530
9,946 9,903 10,628 10,449 10,191 10,744
Sex
Male Female
15,643 10,050
210,663 144,178
155,513 105,877
13,815 14,668
10,198 10,772
Race
White Black Hispanic Asian Other/unknown
12,203 7,815 3,928 1,345 402
165,109 117,002 52,408 14,084 6,238
119,081 85,589 41,741 11,938 3,041
13,839 15,464 13,561 10,636 15,889
9,981 11,313 10,800 9,015 7,747
Primary diagnosis
Diabetes Hypertension GN CKD Other
7,401 6,867 4,412 2,580 4,433
130,813 87,974 47,591 28,212 60,250
86,480 69,467 39,257 23,044 43,142
18,152 13,172 11,036 11,121 13,869
12,000 10,401 9,104 9,084 9,931
Econ 1.5 Total and per person per year Medicare costs of kidney transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 20082010. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
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OPTN/SRTR 2013 Annual Data Report
kidney All recipients
N 108,705
2010 Part A 1,783,535
Part B 855,568
N 112,621
2011 Part A 1,868,994
Part B 851,512
N 115,813
2012 Part A 1,927,726
Part B 860,208
Age
0-11 12-17 18-34 35-49 50-64 65+
1,103 1,757 16,173 32,467 42,144 15,061
27,068 40,058 268,942 486,476 671,732 289,258
7,775 11,598 125,274 249,625 323,058 138,238
1,096 1,749 16,288 33,191 43,973 16,326
27,415 39,038 277,308 500,170 700,348 324,716
7,106 10,226 118,162 242,333 327,656 146,030
1,122 1,723 16,294 33,682 45,641 17,351
30,476 42,402 283,445 508,301 722,427 340,676
7,277 9,845 113,578 241,410 334,927 153,169
Sex
Male Female
65,064 43,641
1,045,498 738,037
505,308 350,260
67,289 45,332
1,102,349 766,645
504,403 347,109
69,263 46,550
1,137,177 790,550
511,882 348,326
Race
White Black Hispanic Asian Other/unknown
63,002 25,455 14,050 4,938 1,260
949,473 505,658 232,347 71,140 24,916
461,603 230,714 120,450 34,251 8,550
64,691 26,617 14,715 5,267 1,331
984,079 530,708 252,375 75,250 26,582
458,084 230,043 120,107 34,657 8,621
66,053 27,494 15,306 5,589 1,371
1,021,248 536,492 262,576 82,680 24,730
466,155 228,486 120,935 36,239 8,393
Primary diagnosis
Diabetes Hypertension GN CKD Other
30,446 23,391 20,670 13,502 20,696
585,721 389,064 289,713 178,460 340,576
277,895 195,076 140,471 88,166 153,960
31,707 24,299 21,198 14,035 21,382
626,386 399,742 298,918 185,207 358,742
280,319 193,118 137,677 88,641 151,757
32,715 25,019 21,568 14,580 21,931
628,130 405,880 317,624 200,721 375,372
283,014 191,649 139,069 91,763 154,712
Econ 1.6 Total calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
All recipients
N 108,705
2010 Part A 18,204
Part B 8,733
N 112,621
2011 Part A 18,355
Part B 8,362
N 115,813
2012 Part A 18,291
Part B 8,162
Age
0-11 12-17 18-34 35-49 50-64 65+
1,103 1,757 16,173 32,467 42,144 15,061
27,363 25,315 18,122 16,447 17,710 22,158
7,860 7,329 8,441 8,439 8,517 10,589
1,096 1,749 16,288 33,191 43,973 16,326
27,982 24,522 18,548 16,477 17,619 22,867
7,253 6,423 7,903 7,983 8,243 10,284
1,122 1,723 16,294 33,682 45,641 17,351
30,252 26,937 18,858 16,388 17,391 22,380
7,223 6,255 7,556 7,783 8,063 10,062
Sex
Male Female
65,064 43,641
17,878 18,687
8,641 8,868
67,289 45,332
18,150 18,657
8,305 8,447
69,263 46,550
18,090 18,589
8,143 8,191
Race
White Black Hispanic Asian Other/unknown
63,002 25,455 14,050 4,938 1,260
16,592 22,479 18,310 15,987 22,338
8,066 10,256 9,492 7,697 7,665
64,691 26,617 14,715 5,267 1,331
16,704 22,383 19,050 15,791 22,316
7,776 9,702 9,066 7,273 7,238
66,053 27,494 15,306 5,589 1,371
16,876 21,729 18,899 16,358 19,997
7,703 9,254 8,704 7,170 6,787
Primary diagnosis
Diabetes Hypertension GN CKD Other
30,446 23,391 20,670 13,502 20,696
21,577 18,622 15,469 14,438 18,070
10,237 9,337 7,500 7,133 8,169
31,707 24,299 21,198 14,035 21,382
22,121 18,332 15,436 14,352 18,459
9,899 8,856 7,110 6,869 7,809
32,715 25,019 21,568 14,580 21,931
21,323 17,921 16,075 14,915 18,705
9,607 8,462 7,038 6,818 7,710
Econ 1.7 Per person per year calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
7 economics
pancreas
Econ 2.2 Rehospitalization rates among pancreas transplant recipients in years 1 and 2 posttransplant Econ 2.1 Medicare coverage among pancreas transplant recipients, 20082012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other Other infection Gastro-intestinal Metabolic, endocrine, nutritional Electrolyte, acid-base and volume depletion Urinary tract infection Bacteremia, viremia and septicemia Immune and hematologic Genito-urinary and breast
% 29.0 12.8 12.7 9.4 6.8 6.0 4.8 3.0 3.0 2.5
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
Year 2 Cause of hospitalization Surgical complications Metabolic, endocrine, nutritional Other infection Gastro-intestinal Other Bacteremia, viremia and septicemia Urinary tract infection Electrolyte, acid-base and volume depletion Genito-urinary and breast Respiratory infection
% 23.1 12.6 12.5 10.7 7.7 5.3 4.8 3.4 3.1 2.8
Econ 2.3 Top 10 causes of rehospitalization among pancreas transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
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OPTN/SRTR 2013 Annual Data Report
pancreas All recipients Age
Total costs ($ in thousands) Part A Part B 174,355 45,503
N 2,020
0-11 12-17 18-34 35-49 50-64 65+
PPPY costs ($) Part A Part B 96,619 25,215
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
489 1,150 370
42,192 95,510 34,911
11,691 25,541 7,956
96,329 93,582 104,234
26,693 25,025 23,755
˚
˚
˚
˚
˚
Sex
Male Female
1,263 757
104,406 69,949
27,833 17,670
93,214 102,191
24,849 25,815
Race
White Black Hispanic Asian Other/unknown
1,288 420 261 30 21
110,269 36,973 21,870 3,105 2,138
27,784 10,236 6,288 718 477
96,034 98,235 93,390 119,235 108,301
24,197 27,196 26,851 27,553 24,179
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
1,685 154 20 161
140,361 12,591 1,617 19,786
37,258 3,648 463 4,134
93,438 90,547 80,623 138,102
24,802 26,237 23,066 28,857
Econ 2.4 Total and per person per year Medicare costs of pancreas transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 1,315
Total costs ($ in thousands) Part A Part B 26,246 16,999
PPPY costs ($) Part A Part B 20,411 13,220
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
323 734 251
7,542 13,207 5,205
4,500 9,509 2,908
23,873 18,340 21,434
14,243 13,205 11,976
˚
˚
˚
˚
˚
Sex
Male Female
823 492
14,757 11,488
10,256 6,743
18,350 23,853
12,753 14,000
Race
White Black Hispanic Asian Other/unknown
865 262 159 18 11
17,875 5,507 2,176 398 289
10,623 3,953 2,060 227 136
21,197 21,391 13,854 23,371 26,189
12,597 15,353 13,119 13,302 12,366
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
1,107 95 17 96
21,183 1,537 285 3,241
14,073 1,304 220 1,402
19,593 16,329 16,690 34,663
13,016 13,849 12,907 14,999
Econ 2.5 Total and per person per year Medicare costs of pancreas transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2010. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewerrecipients are suppressed.
9 economics
pancreas All recipients Age
N 7,794
2010 Part A 155,101
Part B 68,617
N 7,962
2011 Part A 158,269
Part B 67,168
N 8,108
2012 Part A 156,928
Part B 67,072
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
1,957 4,517 1,294 18
43,785 82,949 27,605 532
18,955 38,600 10,775 206
1,978 4,592 1,365 16
45,525 84,057 27,516 541
18,319 37,614 10,910 156
1,982 4,668 1,431 13
44,363 84,300 27,168 392
17,789 37,742 11,204 137
Sex
Male Female
4,693 3,101
88,715 66,387
40,562 28,055
4,765 3,197
89,707 68,562
39,556 27,611
4,845 3,263
89,021 67,907
39,376 27,696
Race
White Black Hispanic Asian Other/unknown
6,082 1,011 581 77 43
113,661 25,584 12,273 1,938 1,646
50,099 11,330 6,064 701 422
6,122 1,079 631 79 51
111,284 27,829 15,021 2,458 1,677
48,195 11,330 6,396 761 486
6,158 1,144 671 78 57
111,614 28,214 13,905 1,671 1,523
48,076 11,484 6,353 639 520
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
6,369 480 38 907
120,290 11,225 648 22,937
55,262 4,780 375 8,200
6,488 506 43 925
122,607 10,258 673 24,730
53,910 4,634 363 8,260
6,636 530 43 899
126,391 9,788 391 20,358
54,240 4,602 287 7,943
Econ 2.6 Total calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
N 7,794
2010 Part A 21,700
Part B 9,600
N 7,962
2011 Part A 21,585
Part B 9,160
N 8,108
2012 Part A 20,850
Part B 8,912
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
1,957 4,517 1,294 18
24,383 19,972 23,484 35,382
10,556 9,294 9,166 13,687
1,978 4,592 1,365 16
24,944 19,805 22,213 35,597
10,037 8,862 8,808 10,288
1,982 4,668 1,431 13
23,961 19,393 20,843 37,136
9,608 8,682 8,595 12,973
Sex
Male Female
4,693 3,101
20,671 23,247
9,451 9,824
4,765 3,197
20,483 23,220
9,032 9,351
4,845 3,263
19,854 22,319
8,782 9,103
Race
White Black Hispanic Asian Other/unknown
6,082 1,011 581 77 43
20,256 28,388 23,352 26,830 44,123
8,929 12,572 11,538 9,708 11,322
6,122 1,079 631 79 51
19,512 29,206 26,721 34,792 38,558
8,450 11,890 11,378 10,771 11,182
6,158 1,144 671 78 57
19,412 27,207 22,614 22,735 29,806
8,361 11,075 10,332 8,697 10,168
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
6,369 480 38 907
20,595 25,820 19,106 27,370
9,461 10,995 11,049 9,785
6,488 506 43 925
20,493 22,189 18,219 29,088
9,011 10,025 9,823 9,716
6,636 530 43 899
20,547 20,149 9,860 23,958
8,818 9,474 7,244 9,348
Econ 2.7 Per person per year calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
10
OPTN/SRTR 2013 Annual Data Report
liver
Econ 3.2 Rehospitalization rates among liver transplant recipients in years 1 and 2 posttransplant Econ 3.1 Medicare coverage among liver transplant recipients, 2008-2012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other Other infection Gastro-intestinal Immune and hematologic Genito-urinary and breast Respiratory infection Electrolyte, acid-base and volume depletion Bacteremia, viremia and septicemia Metabolic, endocrine, nutritional
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
% 28.3 13.1 10.4 9.4 4.3 4.2 3.9 3.7 3.5 2.7
Year 2 Cause of hospitalization Surgical complications Gastro-intestinal Other Other infection Genito-urinary and breast Respiratory infection Bacteremia, viremia and septicemia Metabolic, endocrine, nutritional Immune and hematologic Skin and musculoskeletal
% 18.7 13.3 10.3 8.7 6.1 4.7 4.4 4.0 3.4 3.3
Econ 3.3 Top 10 causes of rehospitalization among liver transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
11 economics
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
Sex
Male Female
Race
Primary diagnosis
N 4,588
Total costs ($ in thousands) Part A Part B 668,027 108,575
PPPY costs ($) Part A Part B 162,620 26,431
10
1,949
351
214,833
˚
˚
˚
˚
38,684
˚
119 582 2,363 1,512
18,572 85,823 341,595 219,889
2,776 14,251 54,644 36,523
175,224 165,060 159,615 165,113
26,192 27,409 25,533 27,425
2,999 1,589
431,666 236,361
69,756 38,818
160,732 166,186
25,974 27,293
White Black Hispanic Asian Other/unknown
3,161 482 694 193 58
449,613 77,648 104,391 28,135 8,241
73,782 11,879 17,007 4,489 1,418
159,303 180,773 166,551 159,761 155,201
26,142 27,656 27,134 25,489 26,698
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
98 1,230 747 341 992 1,180
19,302 184,485 113,214 49,312 126,981 174,734
2,427 29,030 17,634 8,074 22,669 28,740
238,785 169,369 166,174 168,200 139,456 165,971
30,026 26,651 25,883 27,539 24,897 27,299
Econ 3.4 Total and per person per year Medicare costs of liver transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipientss are suppressed. HCV, hepatitis C virus.
All recipients Age
N 2,768
Total costs ($ in thousands) Part A Part B 51,844 25,520
PPPY costs ($) Part A Part B 19,358 9,529
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
77 362 1,458 865
1,868 6,177 29,166 14,384
777 3,202 13,128 8,347
25,542 17,374 20,650 17,307
10,627 9,005 9,295 10,043
Sex
Male Female
1,804 964
32,183 19,660
16,175 9,345
18,447 21,059
9,272 10,010
Race
White Black Hispanic Asian Other/unknown
1,926 283 401 124 34
35,144 6,922 7,473 1,969 336
17,991 2,749 3,649 903 227
18,820 25,708 19,106 16,925 9,858
9,635 10,210 9,330 7,766 6,662
Primary diagnosis
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
53 709 446 195 613 752
742 13,634 8,730 4,292 11,247 13,199
393 5,938 3,888 1,774 5,690 7,836
14,394 19,989 20,069 23,045 19,218 17,883
7,629 8,707 8,938 9,527 9,722 10,617
Econ 3.5 Total and per person per year Medicare costs of liver transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2010. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. HCV, hepatitis C virus.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
liver
12
OPTN/SRTR 2013 Annual Data Report
liver All recipients
N 24,374
2010 Part A 454,065
Part B 143,282
N 26,114
2011 Part A 491,756
Part B 151,339
N 27,753
2012 Part A 509,566
Part B 159,385
Age
0-11 12-17 18-34 35-49 50-64 65+
88 69 954 5,944 13,840 3,479
2,494 671 18,610 97,866 243,211 91,213
652 326 5,325 30,852 76,835 29,292
103 87 1,025 6,125 15,031 3,743
2,860 1,842 20,229 95,993 269,067 101,765
649 470 5,841 30,181 82,726 31,472
120 102 1,076 6,207 16,181 4,067
4,228 1,976 22,656 103,373 274,901 102,433
919 482 6,179 31,750 87,298 32,757
Sex
Male Female
15,794 8,580
287,310 166,754
89,793 53,489
17,037 9,077
310,963 180,793
95,187 56,152
18,104 9,649
328,653 180,913
101,130 58,255
Race
White Black Hispanic Asian Other/unknown
18,484 1,898 2,914 877 201
327,911 48,102 57,074 16,696 4,283
106,506 12,089 18,605 4,861 1,221
19,687 2,072 3,166 963 226
350,037 49,672 70,667 16,601 4,780
111,458 12,898 20,334 5,224 1,425
20,854 2,195 3,409 1,051 244
361,831 53,311 71,564 19,361 3,500
118,119 13,872 20,565 5,677 1,152
Primary diagnosis
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
1,095 6,228 4,919 2,896 2,533 6,703
16,901 126,365 84,447 42,803 56,008 127,541
5,174 36,209 26,558 15,775 16,771 42,795
1,142 6,587 5,203 3,054 2,983 7,145
18,199 131,089 93,245 48,048 66,349 134,827
5,282 37,480 27,807 16,321 19,503 44,945
1,187 6,934 5,421 3,138 3,492 7,581
18,982 138,855 92,500 47,634 70,549 141,046
5,511 39,197 28,344 16,446 22,450 47,437
Econ 3.6 Total calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipient are suppressed. HCV, hepatitis C virus.
All recipients
N 24,374
2010 Part A 20,103
Part B 6,344
N 26,114
2011 Part A 20,311
Part B 6,251
N 27,753
2012 Part A 19,679
Part B 6,155
Age
0-11 12-17 18-34 35-49 50-64 65+
88 69 954 5,944 13,840 3,479
29,015 10,098 20,685 17,389 18,897 30,045
7,590 4,912 5,919 5,482 5,970 9,649
103 87 1,025 6,125 15,031 3,743
28,900 21,682 20,735 16,536 19,264 31,033
6,554 5,530 5,987 5,199 5,923 9,597
120 102 1,076 6,207 16,181 4,067
37,061 19,765 22,054 17,511 18,143 28,471
8,055 4,818 6,015 5,378 5,762 9,105
Sex
Male Female
15,794 8,580
19,649 20,938
6,141 6,716
17,037 9,077
19,737 21,381
6,042 6,640
18,104 9,649
19,488 20,035
5,997 6,451
Race
White Black Hispanic Asian Other/unknown
18,484 1,898 2,914 877 201
19,102 27,878 21,131 20,511 23,862
6,204 7,006 6,888 5,971 6,803
19,687 2,072 3,166 963 226
19,133 26,376 24,232 18,245 23,153
6,092 6,849 6,973 5,741 6,903
20,854 2,195 3,409 1,051 244
18,566 26,412 22,582 19,497 15,570
6,061 6,873 6,489 5,716 5,126
Primary diagnosis
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
1,095 6,228 4,919 2,896 2,533 6,703
16,322 22,146 18,340 15,581 24,989 20,400
4,996 6,346 5,768 5,743 7,483 6,845
1,142 6,587 5,203 3,054 2,983 7,145
16,716 21,625 19,291 16,776 24,952 20,112
4,852 6,183 5,753 5,699 7,335 6,705
1,187 6,934 5,421 3,138 3,492 7,581
16,727 21,649 18,189 15,905 22,344 19,843
4,856 6,111 5,574 5,492 7,110 6,674
Econ 3.7 Per person per year calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. HCV, hepatitis C virus.
13 economics
intestine
Econ 4.2 Rehospitalization rates among intestine transplant recipients in years 1 and 2 posttransplant Econ 4.1 Medicare coverage among intestine transplant recipients, 20082012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
14
OPTN/SRTR 2013 Annual Data Report
intestine Year 1 Cause of hospitalization Surgical complications Other Other infection Electrolyte, acid-base and volume depletion Gastro-intestinal Immune and hematologic Genito-urinary and breast Respiratory Respiratory infection Bacteremia, viremia and septicemia
% 27.0 25.4 10.8 6.5 5.9 5.9
˚ ˚ ˚ ˚
Year 2 Cause of hospitalization Surgical complications Gastro-intestinal Genito-urinary and breast Other Other infection Electrolyte, acid-base and volume depletion Respiratory Respiratory infection Immune and hematologic Urinary tract infection
% 22.8 14.9 11.9 11.9 9.9
˚ ˚ ˚ ˚ ˚
Econ 4.3 Top 10 causes of rehospitalization among intestine transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 60
Total costs ($ in thousands) Part A Part B 16,525 2,048
PPPY costs ($) Part A Part B 343,544 42,568
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
18 27
4,279 8,488
641 957
251,027 390,050
37,575 43,976
˚
˚
˚
˚
˚
Sex
Male Female
24 36
6,963 9,562
840 1,207
361,350 331,645
43,601 41,877
Race
White Black Hispanic Asian Other/unknown
51
14,036
1,719
333,206
40,816
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
Necrotizing enterocolitis Congenital SGS Other SGS Pseudo-obstruction Enteropathies Other/unknown
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
46
12,559
1,514
353,636
42,643
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
11
3,223
394
305,760
37,396
Primary diagnosis
Econ 4.4 Total and per person per year Medicare costs of intestine transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. SGS, short-gut syndrome.
15 economics
intestine All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 217
2010 Part A Part B 11,336 2,655
N 240
2011 Part A Part B 12,265 3,228
N 246
2012 Part A Part B 8,362 2,810
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
61 85 56
2,641 3,687 4,064
832 1,005 590
69 90 67
3,550 3,200 4,543
1,063 1,007 879
69 93 65
2,900 2,565 2,068
950 1,012 605
˚
˚
˚
˚
˚
˚
˚
˚
˚
Sex
Male Female
92 125
4,825 6,511
973 1,683
102 138
5,198 7,067
1,265 1,963
104 142
3,954 4,408
1,151 1,659
Race
White Black Hispanic Asian Other/unknown
182 22
10,043 753
2,229 310
197 26
9,064 1,074
2,617 291
205 25
6,599 972
2,335 264
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
155 21
7,251 1,378
1,647 408
171 23
8,785 1,045
2,120 370
175 23
6,233 904
1,781 460
Primary diagnosis
Necrotizing enterocolitis Congenital SGS Other SGS Pseudo-obstruction Enteropathies Other/unknown
˚
˚
˚
˚
˚
˚
˚
˚
˚
36
2,504
552
42
2,194
701
42
1,050
524
Econ 4.5 Total calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed. SGS, short-gut syndrome.
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 217
2010 Part A Part B 59,533 13,946
N 240
2011 Part A 55,789
Part B 14,683
N 246
2012 Part A Part B 36,611 12,305
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
61 85 56
46,793 48,863 87,745
14,741 13,312 12,729
69 90 67
56,852 37,238 78,256
17,029 11,722 15,144
69 93 65
45,301 29,038 35,183
14,843 11,458 10,290
˚
˚
˚
˚
˚
˚
˚
˚
˚
Sex
Male Female
92 125
62,417 57,561
12,583 14,877
102 138
55,677 55,872
13,550 15,519
104 142
41,552 33,082
12,098 12,453
Race
White Black Hispanic Asian Other/unknown
182 22
62,151 37,622
13,791 15,484
197 26
49,166 49,045
14,193 13,315
205 25
34,589 43,144
12,238 11,702
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
155 21
53,803 71,958
12,221 21,325
171 23
55,504 47,908
13,397 16,979
175 23
38,192 39,828
10,910 20,294
Primary diagnosis
Necrotizing enterocolitis Congenital SGS Other SGS Pseudo-obstruction Enteropathies Other/unknown
˚
˚
˚
˚
˚
˚
˚
˚
˚
36
77,843
17,171
42
61,298
19,590
42
28,726
14,354
Econ 4.6 Per person per year calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. SGS, short-gut syndrome.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
16
OPTN/SRTR 2013 Annual Data Report
heart
Econ 5.2 Rehospitalization rates among heart transplant recipients in years 1 and 2 posttransplant Econ 5.1 Medicare coverage among heart transplant recipients, 2008-2012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other infection Other Respiratory infection Gastro-intestinal Genito-urinary and breast Bacteremia, viremia and septicemia Immune and hematologic Circulatory system Metabolic, endocrine, nutritional
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons are determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
% 26.8 14.4 9.6 7.4 5.7 5.7 3.8 3.3 3.0 3.0
Year 2 Cause of hospitalization Surgical complications Other Gastro-intestinal Other infection Respiratory infection Genito-urinary and breast Skin and musculoskeletal Circulatory system Bacteremia, viremia and septicemia Metabolic, endocrine, nutritional
% 16.6 12.7 11.5 11.2 8.8 6.2 4.6 4.4 3.8 3.5
Econ 5.3 Top 10 causes of rehospitalization among heart transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
17 economics
heart All recipients Age
N 1,989
Total costs ($ in thousands) Part A Part B 482,928 63,054
PPPY costs ($) Part A Part B 266,268 34,766
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
102 325 877 683
25,887 80,503 210,175 164,675
3,286 10,016 27,900 21,794
278,045 270,068 259,238 270,066
35,293 33,600 34,413 35,742
Sex
Male Female
1,517 472
367,081 115,847
48,000 15,054
263,989 273,759
34,519 35,575
Race
White Black Hispanic Asian Other/unknown
1,367 428 143 37 14
328,092 105,488 35,711 10,098 3,539
43,082 13,622 4,517 1,377 456
260,985 276,806 279,400 286,921 284,013
34,270 35,744 35,338 39,137 36,577
Primary diagnosis
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
926 949 43 37 34
223,207 228,380 12,647 8,778 9,917
29,552 29,844 1,307 1,180 1,170
265,346 261,036 358,440 256,412 353,127
35,131 34,112 37,042 34,469 41,679
Econ 5.4 Total and per person per year Medicare costs among heart transplant recipients in year 1 posttransplant Costs among recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after a transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
N 1,219
Total costs ($ in thousands) Part A Part B 26,241 16,462
PPPY costs ($) Part A Part B 21,991 13,796
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
65 211 539 402
1,924 4,738 12,237 7,246
799 2,832 7,348 5,452
30,424 23,317 23,101 18,335
12,639 13,938 13,872 13,796
Sex
Male Female
948 271
19,996 6,245
12,561 3,901
21,569 23,464
13,549 14,657
Race
White Black Hispanic Asian Other/unknown
851 246 91 23
17,041 6,125 2,386 386
11,365 3,488 1,233 267
20,436 25,513 26,644 17,573
13,628 14,527 13,773 12,160
˚
˚
˚
˚
˚
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
565 590 21 24 19
12,726 12,172 386 243 714
7,605 8,050 289 293 225
23,043 20,988 18,331 10,101 44,919
13,769 13,881 13,706 12,174 14,187
Primary diagnosis
Econ 5.5 Total and per person per year Medicare costs among heart transplant recipients in year 2 posttransplant Costs among recipients with Medicare as primary payer at the time of transplant, 20082011. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after a transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
18
OPTN/SRTR 2013 Annual Data Report
heart All recipients
N 12,785
2010 Part A 311,858
Part B 100,096
N 13,193
2011 Part A 336,022
Part B 102,528
N 13,522
2012 Part A 345,151
Part B 104,428
Age
0-11 12-17 18-34 35-49 50-64 65+
44 49 787 2,755 7,404 1,746
1,665 1,192 22,410 57,097 164,897 64,598
411 278 5,783 18,657 55,643 19,324
44 52 830 2,841 7,545 1,881
1,415 1,457 20,816 60,040 177,745 74,550
298 294 5,708 18,508 56,522 21,198
52 54 868 2,794 7,717 2,037
1,469 1,036 22,741 62,586 173,075 84,245
274 207 5,706 18,540 55,987 23,714
Sex
Male Female
10,157 2,628
243,905 67,953
78,909 21,187
10,402 2,791
251,818 84,204
79,615 22,913
10,637 2,885
264,740 80,411
81,164 23,264
Race
White Black Hispanic Asian Other/unknown
10,000 1,737 766 203 79
227,467 53,948 20,768 6,843 2,831
75,990 15,669 6,156 1,725 555
10,247 1,858 789 230 69
239,069 65,208 22,192 8,039 1,514
77,019 16,866 6,049 2,157 437
10,403 1,971 807 257 84
248,018 65,520 20,924 8,592 2,098
79,010 16,530 6,180 2,132 576
Primary diagnosis
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
6,294 5,725 237 334 195
151,608 139,854 6,038 7,734 6,624
49,976 44,110 1,779 2,792 1,439
6,347 6,023 273 349 201
158,257 155,132 7,733 7,909 6,991
50,800 45,633 1,960 2,737 1,397
6,442 6,249 303 333 195
166,352 156,388 8,737 7,666 6,009
51,660 46,492 2,169 2,658 1,450
Econ 5.6 Total calendar-year Medicare costs of heart transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed.
All recipients
N 12,785
2010 Part A 26,284
Part B 8,436
N 13,193
2011 Part A 27,451
Part B 8,376
N 13,522
2012 Part A 27,449
Part B 8,305
Age
0-11 12-17 18-34 35-49 50-64 65+
44 49 787 2,755 7,404 1,746
39,795 25,559 30,654 22,063 23,837 41,948
9,820 5,961 7,910 7,209 8,044 12,549
44 52 830 2,841 7,545 1,881
33,565 30,176 26,681 22,509 25,255 44,783
7,077 6,087 7,316 6,939 8,031 12,734
52 54 868 2,794 7,717 2,037
28,959 19,612 27,940 23,659 24,027 46,601
5,400 3,928 7,011 7,008 7,772 13,118
Sex
Male Female
10,157 2,628
25,885 27,822
8,374 8,675
10,402 2,791
26,000 32,952
8,220 8,967
10,637 2,885
26,727 30,132
8,194 8,718
Race
White Black Hispanic Asian Other/unknown
10,000 1,737 766 203 79
24,400 34,324 29,280 35,867 40,070
8,151 9,969 8,680 9,043 7,849
10,247 1,858 789 230 69
25,029 38,536 30,971 37,470 23,063
8,063 9,967 8,442 10,055 6,654
10,403 1,971 807 257 84
25,491 36,673 28,130 36,441 26,763
8,121 9,252 8,308 9,043 7,352
Primary diagnosis
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
6,294 5,725 237 334 195
25,966 26,365 26,754 24,270 37,347
8,559 8,316 7,881 8,760 8,115
6,347 6,023 273 349 201
26,958 27,669 30,363 24,247 38,281
8,653 8,139 7,695 8,392 7,653
6,442 6,249 303 333 195
27,946 26,791 30,504 24,332 32,911
8,678 7,964 7,573 8,436 7,940
Econ 5.7 Per person per year calendar-year Medicare costs for heart transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer reciepients are suppressed.
19 economics
heart Parameter Intercept Bilirubin at transplant Dialysis at transplant Donor age
Donor cause of death Drug-treated HTN at listing Total ischemia time Medical condition PA pressure, systolic Previous heart transplant Recipient age at transplant Primary diagnosis
Recipient height Recipient weight Recipient race/ethnicity
Recipient serum creatinine Recipient on ECMO Recipient on VAD Recipient on ventilator Sudden death at listing Albumin at transplant Status 1A at transplant Recipient has diabetes Recipient cardiac index Center 2008 transplant volume Multiorgan transplant Death during tx hospitalization Death in 1st year Death in 2nd year Retransplant in 1st year Retransplant in 2nd year
Level Continuous (per mg/dL) Unknown Yes Unknown 0-17 18-34 50-64 65+ CVA Yes Unknown Hours Unknown In ICU Hospitalized not in ICU Continuous (per mm Hg) Unknown Yes 50-64 65+ Cardiomyopathy Congenital heart disease Other/unknown Continuous (per cm) Unknown Continuous (per kg) Unknown Black Hispanic Asian Other/unknown Applies when > 1.5 mg/dL Yes Yes Yes Yes Unknown Continous (per mg/dL) Unknown Yes Yes Continuous (per L/min/m2) Unknown Continuous (per transplant) Yes Yes Yes Yes Yes Yes
At transplant Estimate 165,448 ˚˚˚˚ 909 24,248 23,171 ˚˚ 16,628 2,594 4,881 2,173 -68,515 3,351 -216 12,401 ˚ 5,253 ˚˚˚˚ -16,561 28,118 ˚˚˚˚ 27,117 ˚˚˚˚ -49 4,894 10,184 -1,896 -2,433 -3,406 30,654 ˚˚ -180 -191 -14,582 -127 18,138 5,954 2,036 10,648 14,543 9,551 ˚˚ -5,211 12,235 ˚˚˚ -7,900 1,811 4,554 -4,183 -11,040 11,734 ˚˚˚ 2,024 994 -11,680 822 ˚˚˚˚ 19,483 ˚˚ 40,570 ˚˚˚˚ 0 0 0 0
In first year Estimate 79,183 ˚˚˚˚ -1,594 ˚˚˚ 4,970 12,418 ˚ -9,854 3,487 3,321 -79 18,972 2,319 3,725 ˚ 293 233 -8,518 -5,000 3,980 -188 ˚˚ -838 -11,756 ˚ 1,535 -282 -252 1,129 -87 -58 25,259 124 ˚ 5,194 -2,378 -4,859 5,425 -6,279 628 -14,025 -2,034 -9,954 3,033 -149 -2,330 -3,215 1,525 3,383 265 -8,453 98 ˚ 10,045 ˚ 0 23,125 ˚˚˚˚ 0 430,440 ˚˚˚˚ 0
In second year Estimate 30,984 ˚˚˚˚ 62 945 -5,337 11,362 ˚ 3,766 736 3,717 -11,041 92 884 -2,224 1,050 ˚ -2,401 -735 1,175 -58 -3,864 457 819 -1,038 -813 -25 -2,828 -77 ˚˚ 0 38 0 932 -2,247 -1,599 -3,019 2,252 -2,721 33 288 -1,199 -1,141 401 2,811 -1,100 1,627 677 116 40 4,847 0 0 16,234 ˚˚˚˚ 0 430,440 ˚˚˚˚
Econ 5.8 Predictors of heart transplant costs Predictors of costs paid by Medicare, reported in $US. Year 1 is days 1-365 posttransplant and year 2 days 366-730. Estimates for recipient sex, PRA, and BMI donor/recipient ratio are zero, and are excluded from the table. Estimates for reference categories, not shown, are zero. Reference groups: primary diagnosis, coronary artery disease; race/ethnicity, white. ****P < 0.0001. ***P < 0.001. **P < 0.01. *P < 0.05. CVA, cerebrovascular accident; ECMO, extracorporeal membrane oxygenation; PA, pulmonary artery; VAD, ventricular assist device.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
20
OPTN/SRTR 2013 Annual Data Report
lung
Econ 6.2 Rehospitalization rates among lung transplant recipients in years 1 and 2 posttransplant Econ 6.1 Medicare coverage among lung transplant recipients, 2008-2012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Gastro-intestinal Other Other infection Respiratory infection Respiratory Genito-urinary and breast Bacteremia, viremia and septicemia Conduction disorders and dysrhythmias Immune and hematologic
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
% 43.0 10.0 7.4 5.9 5.4 4.5 3.7 2.9 2.6 2.4
Year 2 Cause of hospitalization Surgical complications Other infection Gastro-intestinal Other Respiratory infection Genito-urinary and breast Respiratory Bacteremia, viremia and septicemia Circulatory system Immune and hematologic
% 36.2 7.9 7.8 7.6 6.8 5.0 4.5 3.3 2.5 2.0
Econ 6.3 Top 10 causes of rehospitalization among lung transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipientss are suppressed.
21 economics
All recipients Age
N 2,010
Total costs ($ in thousands) Part A Part B 373,464 51,166
PPPY costs ($) Part A Part B 207,959 28,491
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
148 192 703 967
29,322 37,999 125,065 181,078
4,134 5,533 16,770 24,729
218,315 221,756 199,004 210,131
30,782 32,288 26,685 28,697
Sex
Male Female
1,216 794
223,071 150,393
30,390 20,776
207,360 208,853
28,250 28,852
Race
White Black Hispanic Asian Other/unknown
1,722 158 92 24 14
317,065 30,422 18,328 5,021 2,628
43,797 4,268 2,123 645 333
204,557 228,804 237,537 220,847 202,258
28,256 32,100 27,512 28,379 25,656
Diagnosis group
A B C D Other/unknown
822 104 179 882 23
140,166 22,349 33,034 174,624 3,292
19,695 3,296 5,059 22,581 536
188,008 253,162 200,484 224,979 155,999
26,417 37,334 30,704 29,092 25,392
Econ 6.4 Total and per person per year Medicare costs of lung transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 20082011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
All recipients Age
N 1,154
Total costs ($ in thousands) Part A Part B 41,366 14,219
PPPY costs ($) Part A Part B 38,522 13,242
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
83 124 421 526
3,527 3,504 15,208 19,127
1,027 1,679 4,859 6,654
45,468 30,668 38,312 39,432
13,239 14,696 12,241 13,718
Sex
Male Female
703 451
22,802 18,564
8,538 5,682
34,913 44,124
13,072 13,505
Race
White Black Hispanic Asian Other/unknown
999 87 47 13
36,535 2,434 1,705 361
12,309 1,015 671 131
39,335 30,338 37,750 30,326
13,252 12,656 14,857 11,013
˚
˚
˚
˚
˚
A B C D Other/unknown
499 61 107 467 20
18,531 2,249 4,024 16,005 558
6,082 700 1,490 5,748 200
39,554 40,458 39,789 37,212 30,096
12,982 12,590 14,736 13,364 10,764
Diagnosis group
Econ 6.5 Total and per person per year Medicare costs of lung transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2010. Year 2 year is from day 366 to day 730 days posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
lung
22
OPTN/SRTR 2013 Annual Data Report
lung All recipients Age
N 5,618
2010 Part A 186,505
Part B 46,245
2011 Part A 216,662
N 6,209
Part B 51,066
N 6,590
2012 Part A 231,328
Part B 53,901
0-11 12-17 18-34 35-49 50-64 65+
˚
˚
˚
˚
˚
˚
˚
˚
˚
17 507 1,028 2,981 1,076
134 16,603 28,375 82,479 58,805
60 4,068 7,606 22,243 12,221
16 576 1,065 3,186 1,358
111 20,266 27,586 90,277 78,186
49 4,345 7,805 23,148 15,650
13 578 1,097 3,350 1,544
383 19,728 32,655 92,950 85,505
75 4,528 8,124 23,672 17,454
Sex
Male Female
3,120 2,498
105,176 81,329
26,260 19,985
3,477 2,732
123,728 92,935
29,455 21,611
3,762 2,828
130,219 101,110
30,678 23,222
Race
White Black Hispanic Asian Other/unknown
4,895 436 209 49 29
158,613 16,032 8,921 1,688 1,251
40,305 3,356 1,940 359 284
5,378 487 244 67 33
185,963 16,570 9,908 2,843 1,379
44,566 3,712 2,011 516 260
5,667 536 272 79 36
199,569 18,070 8,552 4,126 1,011
47,149 3,765 2,026 698 264
Diagnosis group
A B C D Other/unknown
2,583 298 591 1,985 161
78,357 12,776 18,488 73,555 3,329
21,368 2,719 5,091 16,026 1,041
2,733 306 663 2,341 166
88,859 12,316 22,130 90,096 3,262
22,412 2,670 5,469 19,446 1,068
2,727 319 694 2,698 152
89,447 10,681 22,974 105,194 3,033
22,410 2,456 5,945 22,105 985
Econ 6.6 Total calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
All recipients Age
N 5,618
2010 Part A 38,309
Part B 9,499
N 6,209
2011 Part A 40,284
Part B 9,495
N 6,590
2012 Part A 40,010
Part B 9,323
0-11 12-17 18-34 35-49 50-64 65+
˚
˚
˚
˚
˚
˚
˚
˚
˚
17 507 1,028 2,981 1,076
9,585 37,550 30,217 31,205 71,619
4,295 9,200 8,099 8,415 14,884
16 576 1,065 3,186 1,358
7,159 39,628 28,353 32,020 74,379
3,175 8,497 8,022 8,210 14,888
13 578 1,097 3,350 1,544
31,275 38,149 32,653 30,889 69,183
6,114 8,755 8,123 7,867 14,122
Sex
Male Female
3,120 2,498
39,480 36,895
9,857 9,066
3,477 2,732
41,219 39,102
9,813 9,093
3,762 2,828
39,689 40,431
9,350 9,286
Race
White Black Hispanic Asian Other/unknown
4,895 436 209 49 29
37,323 42,682 50,158 41,275 51,466
9,484 8,935 10,910 8,779 11,699
5,378 487 244 67 33
39,994 38,297 47,647 49,223 45,441
9,585 8,579 9,671 8,943 8,583
5,667 536 272 79 36
40,155 38,156 35,607 62,998 31,115
9,487 7,950 8,433 10,660 8,116
Diagnosis group
A B C D Other/unknown
2,583 298 591 1,985 161
34,537 51,804 35,808 43,649 21,971
9,418 11,026 9,860 9,510 6,872
2,733 306 663 2,341 166
37,476 45,135 37,444 45,391 20,569
9,452 9,784 9,253 9,797 6,736
2,727 319 694 2,698 152
37,033 37,081 36,787 45,554 20,970
9,278 8,525 9,520 9,573 6,813
Econ 6.7 Per person per year calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
23 economics
List of Figures/Tables kidney Econ 1.1 Medicare coverage among kidney transplant recipients, 2008-2012 Econ 1.2 Rehospitalization rates among kidney transplant recipients in years 1 and 2 posttransplant Econ 1.3 Top ten causes of rehospitalization among kidney transplant recipients with Medicare primary coverage, 20082010 Econ 1.4 Total and per person per year Medicare costs of kidney transplant recipients in year 1 posttransplant Econ 1.5 Total and per person per year Medicare costs of kidney transplant recipients in year 2 posttransplant Econ 1.6 Total calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012 Econ 1.7 Per person per year calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012
pancreas Econ 2.1 Medicare coverage among pancreas transplant recipients, 2008-2012 Econ 2.2 Rehospitalization rates among pancreas transplant recipients in years 1 and 2 posttransplant Econ 2.3 Top 10 causes of rehospitalization among pancreas transplant recipients with Medicare primary coverage, 2008-2010 Econ 2.4 Total and per person per year Medicare costs of pancreas transplant recipients in year 1 posttransplant Econ 2.5 Total and per person per year Medicare costs of pancreas transplant recipients in year 2 posttransplant Econ 2.6 Total calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012 Econ 2.7 Per person per year calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012
liver Econ 3.1 Medicare coverage among liver transplant recipients, 2008-2012 Econ 3.2 Rehospitalization rates among liver transplant recipients in years 1 and 2 posttransplant Econ 3.3 Top 10 causes of rehospitalization among liver transplant recipients with Medicare primary coverage, 20082010 Econ 3.4 Total and per person per year Medicare costs of liver transplant recipients in year 1 posttransplant Econ 3.5 Total and per person per year Medicare costs of liver transplant recipients in year 2 posttransplant Econ 3.6 Total calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012 Econ 3.7 Per person per year calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012
intestine Econ 4.1 Medicare coverage among intestine transplant recipients, 2008-2012 Econ 4.2 Rehospitalization rates among intestine transplant recipients in years 1 and 2 posttransplant Econ 4.3 Top 10 causes of rehospitalization among intestine transplant recipients with Medicare primary coverage, 2008-2010 Econ 4.4 Total and per person per year Medicare costs of intestine transplant recipients in year 1 posttransplant Econ 4.5 Total calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012 Econ 4.6 Per person per year calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012
heart Econ 5.1 Medicare coverage among heart transplant recipients, 2008-2012 Econ 5.2 Rehospitalization rates among heart transplant recipients in years 1 and 2 posttransplant Econ 5.3 Top 10 causes of rehospitalization among heart transplant recipients with Medicare primary coverage, 20082010 Econ 5.4 Total and per person per year Medicare costs among heart transplant recipients in year 1 posttransplant Econ 5.5 Total and per person per year Medicare costs among heart transplant recipients in year 2 posttransplant Econ 5.6 Total calendar-year Medicare costs of heart transplant recipients, 2010, 2011, and 2012 Econ 5.7 Per person per year calendar-year Medicare costs for heart transplant recipients, 2010, 2011, and 2012
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
24
OPTN/SRTR 2013 Annual Data Report
Econ 5.8 Predictors of heart transplant costs
lung Econ 6.1 Medicare coverage among lung transplant recipients, 2008-2012 Econ 6.2 Rehospitalization rates among lung transplant recipients in years 1 and 2 posttransplant Econ 6.3 Top 10 causes of rehospitalization among lung transplant recipients with Medicare primary coverage, 20082010 Econ 6.4 Total and per person per year Medicare costs of lung transplant recipients in year 1 posttransplant Econ 6.5 Total and per person per year Medicare costs of lung transplant recipients in year 2 posttransplant Econ 6.6 Total calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012 Econ 6.7 Per person per year calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012
kidney ............................. pancreas ......................... liver ................................ intestine .......................... heart ............................... lung ................................
4 7 10 13 16 20
M. A. Schnitzler1,2 , M. A. Skeans1 , D. A. Axelrod3 , K. L. Lentine2 , J. E. Tuttle-Newhall4 , J. J. Snyder1,5 , A. K. Israni1,5,6 , B. L. Kasiske1,6
1
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
2
Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
3
Section of Transplant Surgery, DartmouthHitchcock Medical Center, Lebanon, NH
4
Division of Abdominal Transplant, Saint Louis University School of Medicine, St. Louis, MO
5
Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
6
Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
OPTN/SRTR 2013 Annual Data Report:
Economics
ABSTRACT While the costs to Medicare of solid organ transplant are varied and considerable, the total Medicare expenditure of $4.4 billion for solid organ transplant recipients was less than 1% of all Medicare expenditures in 2012. Kidney transplant remains one of the most cost-effective surgical interventions in medicine. Heart transplant, the most expensive of the major transplants, is likely cost-effective; SRTR has released an Excel-based tool for investigators to use in exploring this question further. It is likely that most solid organ transplants are cost-effective, given the results presented here and the relatively high cost of heart transplant. However, this must be verified with further study.
KEY WORDS Costs and cost analysis, cost-benefit analysis, health expenditures, Medicare.
I still find it so amazing that you were generous enough to give someone you don't even know such a gift. Going through this has shown me that there is still a lot of good in the world.
Keith, heart recipient
2
OPTN/SRTR 2013 Annual Data Report
KIDNEY Kidney transplant is among the most cost-effective procedures in medicine because of the great expense of dialysis as an alternative treatment and the consequences of no treatment. However, kidney transplant is not without considerable direct economic cost. From transplant through 1 year after transplant, the average reimbursement for kidney recipients with primary Medicare coverage was $63 thousand for Part A and $20 thousand for Part B (Figure Econ 1.4). Rehospitalization is a primary driver of interpatient variation in the cost of care. Rehospitalization rates are relatively high in the first year after transplant, with an average of 130 hospitalizations per 100 patient-years at risk, dropping to 59 in the second year (Figure Econ 1.2). The primary causes of rehospitalization are dominated by surgical complications and infections in both the first and second years after transplant (Figure Econ 1.3). The cost of care in the second year is approximately one-third of first-year cost, at $14 thousand for Part A and $10 thousand for Part B (Figure Econ 1.5). The total Part A and Part B Medicare expenditure on kidney transplant recipients was $2.6 billion in 2010 and increased to $2.8 billion in 2012 (Figure Econ 1.6), accounting for 63% of all Medicare expenditures on solid organ transplant recipients in 2012. Patients with diabetes as the cause of kidney failure were the highest expenditure group ($0.9 billion in Parts A and B expenditures in 2012), followed by those with endstage renal disease from hypertension ($0.6 billion in Parts A and B expenditures in 2012) (Figure Econ 1.6).
PANCREAS The average Medicare expenditure for pancreas recipients from the time of transplant through 1 year after transplant was $97 thousand for Part A and $25 thousand for Part B in 2012 (Figure Econ 2.4). These estimates are similar to Medicare's costs for diabetic recipients of a kidney transplant: $70 thousand for Part A and $22 thousand for Part B (Figure Econ 1.4). Pancreas recipients are rehospitalized much less frequently than kidney recipients (Figures Econ 2.2 and
Econ 1.2). This may reflect differences in the underlying disease, type of surgery, and possible complications, as well as differences in patient selection and use of higher-quality organs. The total Medicare expenditure for pancreas recipients in 2012 was $224 million, representing 5% of all Medicare expenditures on solid organ transplant recipients (Figure Econ 2.6).
LIVER Medicare coverage of liver transplant increased from 30% of recipients in 2008 to more than 36% in 2012, and, while many of these patients are of retirement age, a sizable proportion of younger patients were covered by Medicare (Figure Econ 3.1). The average reimbursement for liver recipients with primary Medicare coverage from transplant through 1 year after transplant was $163 thousand and $26 thousand for Part B in 2012 (Figure Econ 3.4), totaling to $189 thousand, which is more than twice the average Medicare expenditure for a kidney transplant recipient (Figure Econ 1.4). However, the long-term costs of care, represented here by cost in the second year after transplant, are similar in liver ($29 thousand) and kidney ($25 thousand) recipients (Figures Econ 3.5 and Econ 1.5, respectively). The total Medicare expenditure on liver recipients in 2012 was $669 million (Figure Econ 3.6), 15% of all Medicare expenditures for solid organ transplant recipients.
INTESTINE Considered at the patient level, Medicare coverage of intestine transplant recipients is proportionally the smallest of all solid organ transplant recipients, at 16% in 2012 (Figure Econ 4.1). However, intestine transplant is the most expensive solid organ transplant reimbursed by Medicare, with average first-year costs of $344 thousand for Part A and $43 thousand for Part B (Figure Econ 4.4), totaling to $387 thousand. The high cost of intestine transplant may in part be a consequence of the high rate of multi-organ transplant with intestine transplant, seen in 48% of Medicare-covered recipients in
3 economics
2008-2011. Because of the small number of procedures, the total Medicare expenditure on intestine transplant recipients in 2012 was $11 million (Figure Econ 4.5), which is less than 1% of all Medicare expenditures on solid organ transplant recipients.
LUNG Medicare paid for some or all of the care for 56% of lung transplant recipients in 2012 (Figure Econ 6.1), the highest percentage among all solid organ transplants other than kidney and pancreas. More than 30% of lung recipients aged 18 to 34 years were covered by Medicare (Figure Econ 6.1). The average Medicare reimbursement from transplant through 1 year after transplant was $208 thousand for Part A and $28 thousand for Part B (Figure Econ 6.4), which is similar to the cost of care for liver transplant recipients but approaches 3 times the cost of care for kidney transplant patients. Rehospitalization is more common after lung transplant than after any other solid organ transplant except intestine transplant. Consequently, second-year average total costs after lung transplant are the highest, at $39 thousand for Part A and $13 thousand for Part B, totaling to $52 thousand (Figure Econ 6.5). However, because of the small total number of lung transplants covered by Medicare, the total Medicare expenditure on lung transplant recipients was relatively small, at $285 million (Figure Econ 6.6), 6% of all Medicare expenditures on solid organ transplant recipients.
HEART Medicare was the largest single payer for heart transplant in the United States, with more than 42% of recipients covered by Medicare in 2012, and, similar to lung transplant, nearly 20% of heart recipients aged 18 to 34 years covered by Medicare (Econ 5.1). The average Medicare reimbursement from transplant through 1 year after transplant was $266 thousand for Part A and $35 thousand for Part B (Figure Econ 5.4), totaling to $301 thousand, representing the second highest average total costs, after intestine transplant. First-year Medicare expenditures for heart transplant recipients were more than 1.5 times greater than the Medicare expenditures for liver transplant recipients and 3 to 4 times those for kidney transplant recipients (Figures Econ 3.4 and Econ 1.4, respectively). However, second-year Medicare costs after heart transplant were closer to second-year costs in liver than in lung transplant, at $22 thousand for Part A and $14 thousand for Part B, totaling to $36 thousand (Figure Econ 6.5). The total Medicare expenditure on heart transplant recipients in 2012 was $450 million, 10% of all Medicare expenditures on solid organ transplant recipients (Figure Econ 5.6).
Heart Cost-Effectiveness
Beginning with this Annual Data Report (ADR), SRTR is releasing multivariate cost estimates suitable for use in costeffectiveness modeling in solid organ transplantation. Heart transplant is the first transplant type addressed; future ADRs will address other solid organ transplant types. Multivariate predictors of cost associated with heart transplant were estimated using robust regression with the Mestimator, because of the presence of influential outliers in the data (Figure Econ 5.8). These estimates facilitate detailed cost analysis that may be applied in the setting of a clinical trial, policy analysis, or comparisons of costs for cohorts of heart transplant recipients. Variable definitions follow exactly from the patient survival equations used in the SRTR heart transplant program-specific reports. Markov modeling techniques can be applied to estimate expected cost and survival after heart transplant. For example, these techniques were applied in a comparison of patients who underwent transplant after they had had a ventricular assist device (VAD) procedure and those who underwent transplant without ever having had a VAD procedure. The VAD was associated with markedly higher costs and lower survival. The total expected discounted cost of care from 1 year before transplant through 20 years after transplant was $505 thousand for a patient with a VAD and $525 thousand for one without a VAD. However, 20-year survival with a VAD is expected to be 17% with 5.53 discounted qualityadjusted life years (QALYs), compared with 26% and 6.28 discounted QALYs without a VAD. Combining cost and effect through 20 years after transplant, patients with a VAD cost $91 thousand per QALY compared with $84 thousand per QALY for those without a VAD. In either case, cost per QALY is generally less than the $100 thousand per QALY generally observed in maintenance dialysis, a common costeffectiveness reference treatment intervention. An Excel-based tool to perform the calculations presented here and other economic calculations in heart transplant is available at www.srtr.org/Exceltools/ SRTRADR2013_HeartEcon.xlsx. This simple example assumes that the characteristics of patients who underwent transplant after receiving a VAD and those without a VAD were otherwise this same. This may or may not be a reasonable assumption; investigators are invited to download the tool and make their own comparisons. This tool could be used for a number of economic analyses in heart transplantation, including comparisons of alternative mechanical treatment strategies, new pharmaceutical interventions, competing allocation policies, and other important questions in solid organ transplantation.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
4
OPTN/SRTR 2013 Annual Data Report
kidney
Econ 1.2 Rehospitalization rates among kidney transplant recipients in years 1 and 2 posttransplant Econ 1.1 Medicare coverage among kidney transplant recipients, 20082012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other infection Other Gastro-intestinal Metabolic, endocrine, nutritional Urinary tract infection Genito-urinary and breast Bacteremia, viremia and septicemia Electrolyte, acid-base and volume depletion Respiratory infection
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year 2 rates on rehospitalizations in the subsequent year.
% 33.2 9.8 8.4 6.2 4.9 4.8 4.1 4.1 3.9 3.3
Year 2 Cause of hospitalization Surgical complications Other infection Other Gastro-intestinal Metabolic, endocrine, nutritional Bacteremia, viremia and septicemia Urinary tract infection Respiratory infection Genito-urinary and breast Skin and musculoskeletal
% 21.4 9.4 8.4 7.4 7.2 5.9 5.7 5.1 4.7 3.0
Econ 1.3 Top ten causes of rehospitalization among kidney transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
5 economics
kidney Total costs ($ in thousands) Part A Part B 2,308,834 722,373
PPPY costs ($) Part A Part B 63,369 19,827
All recipients
N 38,238
Age
0-11 12-17 18-34 35-49 50-64 65+
432 577 4,828 10,406 14,049 7,946
38,273 39,784 271,722 596,815 866,639 495,600
8,239 10,312 93,238 199,255 261,945 149,383
90,662 71,336 58,237 59,673 64,949 66,575
19,517 18,491 19,983 19,923 19,631 20,067
Sex
Male Female
23,311 14,927
1,401,067 907,766
437,222 285,150
63,054 63,862
19,677 20,061
Race
White Black Hispanic Asian Other/unknown
17,965 11,823 5,875 1,993 582
1,080,074 759,730 326,790 109,254 32,986
327,749 236,502 114,491 34,080 9,551
63,131 67,803 57,844 57,061 59,215
19,157 21,107 20,266 17,799 17,145
Primary diagnosis
Diabetes Hypertension GN CKD Other
11,256 10,133 6,396 3,819 6,634
746,070 579,339 333,850 210,048 439,527
233,281 189,602 110,584 65,530 123,376
70,330 60,023 54,139 56,915 69,571
21,991 19,644 17,933 17,756 19,529
Econ 1.4 Total and per person per year Medicare costs of kidney transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after a transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
All recipients
N 25,693
Total costs ($ in thousands) Part A Part B 354,841 261,391
PPPY costs ($) Part A Part B 14,149 10,423
Age
0-11 12-17 18-34 35-49 50-64 65+
315 408 3,362 7,110 9,346 5,152
5,715 9,214 43,732 85,272 133,024 77,885
3,080 3,939 34,841 72,774 92,874 53,884
18,453 23,167 13,341 12,244 14,597 15,530
9,946 9,903 10,628 10,449 10,191 10,744
Sex
Male Female
15,643 10,050
210,663 144,178
155,513 105,877
13,815 14,668
10,198 10,772
Race
White Black Hispanic Asian Other/unknown
12,203 7,815 3,928 1,345 402
165,109 117,002 52,408 14,084 6,238
119,081 85,589 41,741 11,938 3,041
13,839 15,464 13,561 10,636 15,889
9,981 11,313 10,800 9,015 7,747
Primary diagnosis
Diabetes Hypertension GN CKD Other
7,401 6,867 4,412 2,580 4,433
130,813 87,974 47,591 28,212 60,250
86,480 69,467 39,257 23,044 43,142
18,152 13,172 11,036 11,121 13,869
12,000 10,401 9,104 9,084 9,931
Econ 1.5 Total and per person per year Medicare costs of kidney transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 20082010. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
6
OPTN/SRTR 2013 Annual Data Report
kidney All recipients
N 108,705
2010 Part A 1,783,535
Part B 855,568
N 112,621
2011 Part A 1,868,994
Part B 851,512
N 115,813
2012 Part A 1,927,726
Part B 860,208
Age
0-11 12-17 18-34 35-49 50-64 65+
1,103 1,757 16,173 32,467 42,144 15,061
27,068 40,058 268,942 486,476 671,732 289,258
7,775 11,598 125,274 249,625 323,058 138,238
1,096 1,749 16,288 33,191 43,973 16,326
27,415 39,038 277,308 500,170 700,348 324,716
7,106 10,226 118,162 242,333 327,656 146,030
1,122 1,723 16,294 33,682 45,641 17,351
30,476 42,402 283,445 508,301 722,427 340,676
7,277 9,845 113,578 241,410 334,927 153,169
Sex
Male Female
65,064 43,641
1,045,498 738,037
505,308 350,260
67,289 45,332
1,102,349 766,645
504,403 347,109
69,263 46,550
1,137,177 790,550
511,882 348,326
Race
White Black Hispanic Asian Other/unknown
63,002 25,455 14,050 4,938 1,260
949,473 505,658 232,347 71,140 24,916
461,603 230,714 120,450 34,251 8,550
64,691 26,617 14,715 5,267 1,331
984,079 530,708 252,375 75,250 26,582
458,084 230,043 120,107 34,657 8,621
66,053 27,494 15,306 5,589 1,371
1,021,248 536,492 262,576 82,680 24,730
466,155 228,486 120,935 36,239 8,393
Primary diagnosis
Diabetes Hypertension GN CKD Other
30,446 23,391 20,670 13,502 20,696
585,721 389,064 289,713 178,460 340,576
277,895 195,076 140,471 88,166 153,960
31,707 24,299 21,198 14,035 21,382
626,386 399,742 298,918 185,207 358,742
280,319 193,118 137,677 88,641 151,757
32,715 25,019 21,568 14,580 21,931
628,130 405,880 317,624 200,721 375,372
283,014 191,649 139,069 91,763 154,712
Econ 1.6 Total calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
All recipients
N 108,705
2010 Part A 18,204
Part B 8,733
N 112,621
2011 Part A 18,355
Part B 8,362
N 115,813
2012 Part A 18,291
Part B 8,162
Age
0-11 12-17 18-34 35-49 50-64 65+
1,103 1,757 16,173 32,467 42,144 15,061
27,363 25,315 18,122 16,447 17,710 22,158
7,860 7,329 8,441 8,439 8,517 10,589
1,096 1,749 16,288 33,191 43,973 16,326
27,982 24,522 18,548 16,477 17,619 22,867
7,253 6,423 7,903 7,983 8,243 10,284
1,122 1,723 16,294 33,682 45,641 17,351
30,252 26,937 18,858 16,388 17,391 22,380
7,223 6,255 7,556 7,783 8,063 10,062
Sex
Male Female
65,064 43,641
17,878 18,687
8,641 8,868
67,289 45,332
18,150 18,657
8,305 8,447
69,263 46,550
18,090 18,589
8,143 8,191
Race
White Black Hispanic Asian Other/unknown
63,002 25,455 14,050 4,938 1,260
16,592 22,479 18,310 15,987 22,338
8,066 10,256 9,492 7,697 7,665
64,691 26,617 14,715 5,267 1,331
16,704 22,383 19,050 15,791 22,316
7,776 9,702 9,066 7,273 7,238
66,053 27,494 15,306 5,589 1,371
16,876 21,729 18,899 16,358 19,997
7,703 9,254 8,704 7,170 6,787
Primary diagnosis
Diabetes Hypertension GN CKD Other
30,446 23,391 20,670 13,502 20,696
21,577 18,622 15,469 14,438 18,070
10,237 9,337 7,500 7,133 8,169
31,707 24,299 21,198 14,035 21,382
22,121 18,332 15,436 14,352 18,459
9,899 8,856 7,110 6,869 7,809
32,715 25,019 21,568 14,580 21,931
21,323 17,921 16,075 14,915 18,705
9,607 8,462 7,038 6,818 7,710
Econ 1.7 Per person per year calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. GN, glomerulonephritis; CKD, cystic kidney disease.
7 economics
pancreas
Econ 2.2 Rehospitalization rates among pancreas transplant recipients in years 1 and 2 posttransplant Econ 2.1 Medicare coverage among pancreas transplant recipients, 20082012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other Other infection Gastro-intestinal Metabolic, endocrine, nutritional Electrolyte, acid-base and volume depletion Urinary tract infection Bacteremia, viremia and septicemia Immune and hematologic Genito-urinary and breast
% 29.0 12.8 12.7 9.4 6.8 6.0 4.8 3.0 3.0 2.5
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
Year 2 Cause of hospitalization Surgical complications Metabolic, endocrine, nutritional Other infection Gastro-intestinal Other Bacteremia, viremia and septicemia Urinary tract infection Electrolyte, acid-base and volume depletion Genito-urinary and breast Respiratory infection
% 23.1 12.6 12.5 10.7 7.7 5.3 4.8 3.4 3.1 2.8
Econ 2.3 Top 10 causes of rehospitalization among pancreas transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
8
OPTN/SRTR 2013 Annual Data Report
pancreas All recipients Age
Total costs ($ in thousands) Part A Part B 174,355 45,503
N 2,020
0-11 12-17 18-34 35-49 50-64 65+
PPPY costs ($) Part A Part B 96,619 25,215
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
489 1,150 370
42,192 95,510 34,911
11,691 25,541 7,956
96,329 93,582 104,234
26,693 25,025 23,755
˚
˚
˚
˚
˚
Sex
Male Female
1,263 757
104,406 69,949
27,833 17,670
93,214 102,191
24,849 25,815
Race
White Black Hispanic Asian Other/unknown
1,288 420 261 30 21
110,269 36,973 21,870 3,105 2,138
27,784 10,236 6,288 718 477
96,034 98,235 93,390 119,235 108,301
24,197 27,196 26,851 27,553 24,179
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
1,685 154 20 161
140,361 12,591 1,617 19,786
37,258 3,648 463 4,134
93,438 90,547 80,623 138,102
24,802 26,237 23,066 28,857
Econ 2.4 Total and per person per year Medicare costs of pancreas transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 1,315
Total costs ($ in thousands) Part A Part B 26,246 16,999
PPPY costs ($) Part A Part B 20,411 13,220
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
323 734 251
7,542 13,207 5,205
4,500 9,509 2,908
23,873 18,340 21,434
14,243 13,205 11,976
˚
˚
˚
˚
˚
Sex
Male Female
823 492
14,757 11,488
10,256 6,743
18,350 23,853
12,753 14,000
Race
White Black Hispanic Asian Other/unknown
865 262 159 18 11
17,875 5,507 2,176 398 289
10,623 3,953 2,060 227 136
21,197 21,391 13,854 23,371 26,189
12,597 15,353 13,119 13,302 12,366
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
1,107 95 17 96
21,183 1,537 285 3,241
14,073 1,304 220 1,402
19,593 16,329 16,690 34,663
13,016 13,849 12,907 14,999
Econ 2.5 Total and per person per year Medicare costs of pancreas transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2010. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewerrecipients are suppressed.
9 economics
pancreas All recipients Age
N 7,794
2010 Part A 155,101
Part B 68,617
N 7,962
2011 Part A 158,269
Part B 67,168
N 8,108
2012 Part A 156,928
Part B 67,072
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
1,957 4,517 1,294 18
43,785 82,949 27,605 532
18,955 38,600 10,775 206
1,978 4,592 1,365 16
45,525 84,057 27,516 541
18,319 37,614 10,910 156
1,982 4,668 1,431 13
44,363 84,300 27,168 392
17,789 37,742 11,204 137
Sex
Male Female
4,693 3,101
88,715 66,387
40,562 28,055
4,765 3,197
89,707 68,562
39,556 27,611
4,845 3,263
89,021 67,907
39,376 27,696
Race
White Black Hispanic Asian Other/unknown
6,082 1,011 581 77 43
113,661 25,584 12,273 1,938 1,646
50,099 11,330 6,064 701 422
6,122 1,079 631 79 51
111,284 27,829 15,021 2,458 1,677
48,195 11,330 6,396 761 486
6,158 1,144 671 78 57
111,614 28,214 13,905 1,671 1,523
48,076 11,484 6,353 639 520
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
6,369 480 38 907
120,290 11,225 648 22,937
55,262 4,780 375 8,200
6,488 506 43 925
122,607 10,258 673 24,730
53,910 4,634 363 8,260
6,636 530 43 899
126,391 9,788 391 20,358
54,240 4,602 287 7,943
Econ 2.6 Total calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
N 7,794
2010 Part A 21,700
Part B 9,600
N 7,962
2011 Part A 21,585
Part B 9,160
N 8,108
2012 Part A 20,850
Part B 8,912
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
1,957 4,517 1,294 18
24,383 19,972 23,484 35,382
10,556 9,294 9,166 13,687
1,978 4,592 1,365 16
24,944 19,805 22,213 35,597
10,037 8,862 8,808 10,288
1,982 4,668 1,431 13
23,961 19,393 20,843 37,136
9,608 8,682 8,595 12,973
Sex
Male Female
4,693 3,101
20,671 23,247
9,451 9,824
4,765 3,197
20,483 23,220
9,032 9,351
4,845 3,263
19,854 22,319
8,782 9,103
Race
White Black Hispanic Asian Other/unknown
6,082 1,011 581 77 43
20,256 28,388 23,352 26,830 44,123
8,929 12,572 11,538 9,708 11,322
6,122 1,079 631 79 51
19,512 29,206 26,721 34,792 38,558
8,450 11,890 11,378 10,771 11,182
6,158 1,144 671 78 57
19,412 27,207 22,614 22,735 29,806
8,361 11,075 10,332 8,697 10,168
Primary diagnosis
Diabetes type 1 Diabetes type 2 Diabetes type unknown Other/unknown
6,369 480 38 907
20,595 25,820 19,106 27,370
9,461 10,995 11,049 9,785
6,488 506 43 925
20,493 22,189 18,219 29,088
9,011 10,025 9,823 9,716
6,636 530 43 899
20,547 20,149 9,860 23,958
8,818 9,474 7,244 9,348
Econ 2.7 Per person per year calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
10
OPTN/SRTR 2013 Annual Data Report
liver
Econ 3.2 Rehospitalization rates among liver transplant recipients in years 1 and 2 posttransplant Econ 3.1 Medicare coverage among liver transplant recipients, 2008-2012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other Other infection Gastro-intestinal Immune and hematologic Genito-urinary and breast Respiratory infection Electrolyte, acid-base and volume depletion Bacteremia, viremia and septicemia Metabolic, endocrine, nutritional
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
% 28.3 13.1 10.4 9.4 4.3 4.2 3.9 3.7 3.5 2.7
Year 2 Cause of hospitalization Surgical complications Gastro-intestinal Other Other infection Genito-urinary and breast Respiratory infection Bacteremia, viremia and septicemia Metabolic, endocrine, nutritional Immune and hematologic Skin and musculoskeletal
% 18.7 13.3 10.3 8.7 6.1 4.7 4.4 4.0 3.4 3.3
Econ 3.3 Top 10 causes of rehospitalization among liver transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
11 economics
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
Sex
Male Female
Race
Primary diagnosis
N 4,588
Total costs ($ in thousands) Part A Part B 668,027 108,575
PPPY costs ($) Part A Part B 162,620 26,431
10
1,949
351
214,833
˚
˚
˚
˚
38,684
˚
119 582 2,363 1,512
18,572 85,823 341,595 219,889
2,776 14,251 54,644 36,523
175,224 165,060 159,615 165,113
26,192 27,409 25,533 27,425
2,999 1,589
431,666 236,361
69,756 38,818
160,732 166,186
25,974 27,293
White Black Hispanic Asian Other/unknown
3,161 482 694 193 58
449,613 77,648 104,391 28,135 8,241
73,782 11,879 17,007 4,489 1,418
159,303 180,773 166,551 159,761 155,201
26,142 27,656 27,134 25,489 26,698
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
98 1,230 747 341 992 1,180
19,302 184,485 113,214 49,312 126,981 174,734
2,427 29,030 17,634 8,074 22,669 28,740
238,785 169,369 166,174 168,200 139,456 165,971
30,026 26,651 25,883 27,539 24,897 27,299
Econ 3.4 Total and per person per year Medicare costs of liver transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipientss are suppressed. HCV, hepatitis C virus.
All recipients Age
N 2,768
Total costs ($ in thousands) Part A Part B 51,844 25,520
PPPY costs ($) Part A Part B 19,358 9,529
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
77 362 1,458 865
1,868 6,177 29,166 14,384
777 3,202 13,128 8,347
25,542 17,374 20,650 17,307
10,627 9,005 9,295 10,043
Sex
Male Female
1,804 964
32,183 19,660
16,175 9,345
18,447 21,059
9,272 10,010
Race
White Black Hispanic Asian Other/unknown
1,926 283 401 124 34
35,144 6,922 7,473 1,969 336
17,991 2,749 3,649 903 227
18,820 25,708 19,106 16,925 9,858
9,635 10,210 9,330 7,766 6,662
Primary diagnosis
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
53 709 446 195 613 752
742 13,634 8,730 4,292 11,247 13,199
393 5,938 3,888 1,774 5,690 7,836
14,394 19,989 20,069 23,045 19,218 17,883
7,629 8,707 8,938 9,527 9,722 10,617
Econ 3.5 Total and per person per year Medicare costs of liver transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2010. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. HCV, hepatitis C virus.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
liver
12
OPTN/SRTR 2013 Annual Data Report
liver All recipients
N 24,374
2010 Part A 454,065
Part B 143,282
N 26,114
2011 Part A 491,756
Part B 151,339
N 27,753
2012 Part A 509,566
Part B 159,385
Age
0-11 12-17 18-34 35-49 50-64 65+
88 69 954 5,944 13,840 3,479
2,494 671 18,610 97,866 243,211 91,213
652 326 5,325 30,852 76,835 29,292
103 87 1,025 6,125 15,031 3,743
2,860 1,842 20,229 95,993 269,067 101,765
649 470 5,841 30,181 82,726 31,472
120 102 1,076 6,207 16,181 4,067
4,228 1,976 22,656 103,373 274,901 102,433
919 482 6,179 31,750 87,298 32,757
Sex
Male Female
15,794 8,580
287,310 166,754
89,793 53,489
17,037 9,077
310,963 180,793
95,187 56,152
18,104 9,649
328,653 180,913
101,130 58,255
Race
White Black Hispanic Asian Other/unknown
18,484 1,898 2,914 877 201
327,911 48,102 57,074 16,696 4,283
106,506 12,089 18,605 4,861 1,221
19,687 2,072 3,166 963 226
350,037 49,672 70,667 16,601 4,780
111,458 12,898 20,334 5,224 1,425
20,854 2,195 3,409 1,051 244
361,831 53,311 71,564 19,361 3,500
118,119 13,872 20,565 5,677 1,152
Primary diagnosis
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
1,095 6,228 4,919 2,896 2,533 6,703
16,901 126,365 84,447 42,803 56,008 127,541
5,174 36,209 26,558 15,775 16,771 42,795
1,142 6,587 5,203 3,054 2,983 7,145
18,199 131,089 93,245 48,048 66,349 134,827
5,282 37,480 27,807 16,321 19,503 44,945
1,187 6,934 5,421 3,138 3,492 7,581
18,982 138,855 92,500 47,634 70,549 141,046
5,511 39,197 28,344 16,446 22,450 47,437
Econ 3.6 Total calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipient are suppressed. HCV, hepatitis C virus.
All recipients
N 24,374
2010 Part A 20,103
Part B 6,344
N 26,114
2011 Part A 20,311
Part B 6,251
N 27,753
2012 Part A 19,679
Part B 6,155
Age
0-11 12-17 18-34 35-49 50-64 65+
88 69 954 5,944 13,840 3,479
29,015 10,098 20,685 17,389 18,897 30,045
7,590 4,912 5,919 5,482 5,970 9,649
103 87 1,025 6,125 15,031 3,743
28,900 21,682 20,735 16,536 19,264 31,033
6,554 5,530 5,987 5,199 5,923 9,597
120 102 1,076 6,207 16,181 4,067
37,061 19,765 22,054 17,511 18,143 28,471
8,055 4,818 6,015 5,378 5,762 9,105
Sex
Male Female
15,794 8,580
19,649 20,938
6,141 6,716
17,037 9,077
19,737 21,381
6,042 6,640
18,104 9,649
19,488 20,035
5,997 6,451
Race
White Black Hispanic Asian Other/unknown
18,484 1,898 2,914 877 201
19,102 27,878 21,131 20,511 23,862
6,204 7,006 6,888 5,971 6,803
19,687 2,072 3,166 963 226
19,133 26,376 24,232 18,245 23,153
6,092 6,849 6,973 5,741 6,903
20,854 2,195 3,409 1,051 244
18,566 26,412 22,582 19,497 15,570
6,061 6,873 6,489 5,716 5,126
Primary diagnosis
Acute hepatic necrosis HCV Alcoholic liver disease Cholestatic disease Malignancy Other/unknown
1,095 6,228 4,919 2,896 2,533 6,703
16,322 22,146 18,340 15,581 24,989 20,400
4,996 6,346 5,768 5,743 7,483 6,845
1,142 6,587 5,203 3,054 2,983 7,145
16,716 21,625 19,291 16,776 24,952 20,112
4,852 6,183 5,753 5,699 7,335 6,705
1,187 6,934 5,421 3,138 3,492 7,581
16,727 21,649 18,189 15,905 22,344 19,843
4,856 6,111 5,574 5,492 7,110 6,674
Econ 3.7 Per person per year calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. HCV, hepatitis C virus.
13 economics
intestine
Econ 4.2 Rehospitalization rates among intestine transplant recipients in years 1 and 2 posttransplant Econ 4.1 Medicare coverage among intestine transplant recipients, 20082012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
14
OPTN/SRTR 2013 Annual Data Report
intestine Year 1 Cause of hospitalization Surgical complications Other Other infection Electrolyte, acid-base and volume depletion Gastro-intestinal Immune and hematologic Genito-urinary and breast Respiratory Respiratory infection Bacteremia, viremia and septicemia
% 27.0 25.4 10.8 6.5 5.9 5.9
˚ ˚ ˚ ˚
Year 2 Cause of hospitalization Surgical complications Gastro-intestinal Genito-urinary and breast Other Other infection Electrolyte, acid-base and volume depletion Respiratory Respiratory infection Immune and hematologic Urinary tract infection
% 22.8 14.9 11.9 11.9 9.9
˚ ˚ ˚ ˚ ˚
Econ 4.3 Top 10 causes of rehospitalization among intestine transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 60
Total costs ($ in thousands) Part A Part B 16,525 2,048
PPPY costs ($) Part A Part B 343,544 42,568
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
18 27
4,279 8,488
641 957
251,027 390,050
37,575 43,976
˚
˚
˚
˚
˚
Sex
Male Female
24 36
6,963 9,562
840 1,207
361,350 331,645
43,601 41,877
Race
White Black Hispanic Asian Other/unknown
51
14,036
1,719
333,206
40,816
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
˚ ˚ ˚ ˚
Necrotizing enterocolitis Congenital SGS Other SGS Pseudo-obstruction Enteropathies Other/unknown
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
46
12,559
1,514
353,636
42,643
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
11
3,223
394
305,760
37,396
Primary diagnosis
Econ 4.4 Total and per person per year Medicare costs of intestine transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. SGS, short-gut syndrome.
15 economics
intestine All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 217
2010 Part A Part B 11,336 2,655
N 240
2011 Part A Part B 12,265 3,228
N 246
2012 Part A Part B 8,362 2,810
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
61 85 56
2,641 3,687 4,064
832 1,005 590
69 90 67
3,550 3,200 4,543
1,063 1,007 879
69 93 65
2,900 2,565 2,068
950 1,012 605
˚
˚
˚
˚
˚
˚
˚
˚
˚
Sex
Male Female
92 125
4,825 6,511
973 1,683
102 138
5,198 7,067
1,265 1,963
104 142
3,954 4,408
1,151 1,659
Race
White Black Hispanic Asian Other/unknown
182 22
10,043 753
2,229 310
197 26
9,064 1,074
2,617 291
205 25
6,599 972
2,335 264
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
155 21
7,251 1,378
1,647 408
171 23
8,785 1,045
2,120 370
175 23
6,233 904
1,781 460
Primary diagnosis
Necrotizing enterocolitis Congenital SGS Other SGS Pseudo-obstruction Enteropathies Other/unknown
˚
˚
˚
˚
˚
˚
˚
˚
˚
36
2,504
552
42
2,194
701
42
1,050
524
Econ 4.5 Total calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed. SGS, short-gut syndrome.
All recipients Age
0-11 12-17 18-34 35-49 50-64 65+
N 217
2010 Part A Part B 59,533 13,946
N 240
2011 Part A 55,789
Part B 14,683
N 246
2012 Part A Part B 36,611 12,305
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
61 85 56
46,793 48,863 87,745
14,741 13,312 12,729
69 90 67
56,852 37,238 78,256
17,029 11,722 15,144
69 93 65
45,301 29,038 35,183
14,843 11,458 10,290
˚
˚
˚
˚
˚
˚
˚
˚
˚
Sex
Male Female
92 125
62,417 57,561
12,583 14,877
102 138
55,677 55,872
13,550 15,519
104 142
41,552 33,082
12,098 12,453
Race
White Black Hispanic Asian Other/unknown
182 22
62,151 37,622
13,791 15,484
197 26
49,166 49,045
14,193 13,315
205 25
34,589 43,144
12,238 11,702
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
155 21
53,803 71,958
12,221 21,325
171 23
55,504 47,908
13,397 16,979
175 23
38,192 39,828
10,910 20,294
Primary diagnosis
Necrotizing enterocolitis Congenital SGS Other SGS Pseudo-obstruction Enteropathies Other/unknown
˚
˚
˚
˚
˚
˚
˚
˚
˚
36
77,843
17,171
42
61,298
19,590
42
28,726
14,354
Econ 4.6 Per person per year calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. SGS, short-gut syndrome.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
16
OPTN/SRTR 2013 Annual Data Report
heart
Econ 5.2 Rehospitalization rates among heart transplant recipients in years 1 and 2 posttransplant Econ 5.1 Medicare coverage among heart transplant recipients, 2008-2012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Other infection Other Respiratory infection Gastro-intestinal Genito-urinary and breast Bacteremia, viremia and septicemia Immune and hematologic Circulatory system Metabolic, endocrine, nutritional
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons are determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
% 26.8 14.4 9.6 7.4 5.7 5.7 3.8 3.3 3.0 3.0
Year 2 Cause of hospitalization Surgical complications Other Gastro-intestinal Other infection Respiratory infection Genito-urinary and breast Skin and musculoskeletal Circulatory system Bacteremia, viremia and septicemia Metabolic, endocrine, nutritional
% 16.6 12.7 11.5 11.2 8.8 6.2 4.6 4.4 3.8 3.5
Econ 5.3 Top 10 causes of rehospitalization among heart transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipients are suppressed.
17 economics
heart All recipients Age
N 1,989
Total costs ($ in thousands) Part A Part B 482,928 63,054
PPPY costs ($) Part A Part B 266,268 34,766
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
102 325 877 683
25,887 80,503 210,175 164,675
3,286 10,016 27,900 21,794
278,045 270,068 259,238 270,066
35,293 33,600 34,413 35,742
Sex
Male Female
1,517 472
367,081 115,847
48,000 15,054
263,989 273,759
34,519 35,575
Race
White Black Hispanic Asian Other/unknown
1,367 428 143 37 14
328,092 105,488 35,711 10,098 3,539
43,082 13,622 4,517 1,377 456
260,985 276,806 279,400 286,921 284,013
34,270 35,744 35,338 39,137 36,577
Primary diagnosis
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
926 949 43 37 34
223,207 228,380 12,647 8,778 9,917
29,552 29,844 1,307 1,180 1,170
265,346 261,036 358,440 256,412 353,127
35,131 34,112 37,042 34,469 41,679
Econ 5.4 Total and per person per year Medicare costs among heart transplant recipients in year 1 posttransplant Costs among recipients with Medicare as primary payer at the time of transplant, 2008-2011. Year-1 costs include the transplant hospitalization. Costs incurred after a transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed.
All recipients Age
N 1,219
Total costs ($ in thousands) Part A Part B 26,241 16,462
PPPY costs ($) Part A Part B 21,991 13,796
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
65 211 539 402
1,924 4,738 12,237 7,246
799 2,832 7,348 5,452
30,424 23,317 23,101 18,335
12,639 13,938 13,872 13,796
Sex
Male Female
948 271
19,996 6,245
12,561 3,901
21,569 23,464
13,549 14,657
Race
White Black Hispanic Asian Other/unknown
851 246 91 23
17,041 6,125 2,386 386
11,365 3,488 1,233 267
20,436 25,513 26,644 17,573
13,628 14,527 13,773 12,160
˚
˚
˚
˚
˚
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
565 590 21 24 19
12,726 12,172 386 243 714
7,605 8,050 289 293 225
23,043 20,988 18,331 10,101 44,919
13,769 13,881 13,706 12,174 14,187
Primary diagnosis
Econ 5.5 Total and per person per year Medicare costs among heart transplant recipients in year 2 posttransplant Costs among recipients with Medicare as primary payer at the time of transplant, 20082011. Year 2 is from day 366 to day 730 posttransplant. Costs incurred after a transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
18
OPTN/SRTR 2013 Annual Data Report
heart All recipients
N 12,785
2010 Part A 311,858
Part B 100,096
N 13,193
2011 Part A 336,022
Part B 102,528
N 13,522
2012 Part A 345,151
Part B 104,428
Age
0-11 12-17 18-34 35-49 50-64 65+
44 49 787 2,755 7,404 1,746
1,665 1,192 22,410 57,097 164,897 64,598
411 278 5,783 18,657 55,643 19,324
44 52 830 2,841 7,545 1,881
1,415 1,457 20,816 60,040 177,745 74,550
298 294 5,708 18,508 56,522 21,198
52 54 868 2,794 7,717 2,037
1,469 1,036 22,741 62,586 173,075 84,245
274 207 5,706 18,540 55,987 23,714
Sex
Male Female
10,157 2,628
243,905 67,953
78,909 21,187
10,402 2,791
251,818 84,204
79,615 22,913
10,637 2,885
264,740 80,411
81,164 23,264
Race
White Black Hispanic Asian Other/unknown
10,000 1,737 766 203 79
227,467 53,948 20,768 6,843 2,831
75,990 15,669 6,156 1,725 555
10,247 1,858 789 230 69
239,069 65,208 22,192 8,039 1,514
77,019 16,866 6,049 2,157 437
10,403 1,971 807 257 84
248,018 65,520 20,924 8,592 2,098
79,010 16,530 6,180 2,132 576
Primary diagnosis
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
6,294 5,725 237 334 195
151,608 139,854 6,038 7,734 6,624
49,976 44,110 1,779 2,792 1,439
6,347 6,023 273 349 201
158,257 155,132 7,733 7,909 6,991
50,800 45,633 1,960 2,737 1,397
6,442 6,249 303 333 195
166,352 156,388 8,737 7,666 6,009
51,660 46,492 2,169 2,658 1,450
Econ 5.6 Total calendar-year Medicare costs of heart transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed.
All recipients
N 12,785
2010 Part A 26,284
Part B 8,436
N 13,193
2011 Part A 27,451
Part B 8,376
N 13,522
2012 Part A 27,449
Part B 8,305
Age
0-11 12-17 18-34 35-49 50-64 65+
44 49 787 2,755 7,404 1,746
39,795 25,559 30,654 22,063 23,837 41,948
9,820 5,961 7,910 7,209 8,044 12,549
44 52 830 2,841 7,545 1,881
33,565 30,176 26,681 22,509 25,255 44,783
7,077 6,087 7,316 6,939 8,031 12,734
52 54 868 2,794 7,717 2,037
28,959 19,612 27,940 23,659 24,027 46,601
5,400 3,928 7,011 7,008 7,772 13,118
Sex
Male Female
10,157 2,628
25,885 27,822
8,374 8,675
10,402 2,791
26,000 32,952
8,220 8,967
10,637 2,885
26,727 30,132
8,194 8,718
Race
White Black Hispanic Asian Other/unknown
10,000 1,737 766 203 79
24,400 34,324 29,280 35,867 40,070
8,151 9,969 8,680 9,043 7,849
10,247 1,858 789 230 69
25,029 38,536 30,971 37,470 23,063
8,063 9,967 8,442 10,055 6,654
10,403 1,971 807 257 84
25,491 36,673 28,130 36,441 26,763
8,121 9,252 8,308 9,043 7,352
Primary diagnosis
Coronary artery disease Cardiomyopathy Congenital disease Valvular disease Other/unknown
6,294 5,725 237 334 195
25,966 26,365 26,754 24,270 37,347
8,559 8,316 7,881 8,760 8,115
6,347 6,023 273 349 201
26,958 27,669 30,363 24,247 38,281
8,653 8,139 7,695 8,392 7,653
6,442 6,249 303 333 195
27,946 26,791 30,504 24,332 32,911
8,678 7,964 7,573 8,436 7,940
Econ 5.7 Per person per year calendar-year Medicare costs for heart transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer reciepients are suppressed.
19 economics
heart Parameter Intercept Bilirubin at transplant Dialysis at transplant Donor age
Donor cause of death Drug-treated HTN at listing Total ischemia time Medical condition PA pressure, systolic Previous heart transplant Recipient age at transplant Primary diagnosis
Recipient height Recipient weight Recipient race/ethnicity
Recipient serum creatinine Recipient on ECMO Recipient on VAD Recipient on ventilator Sudden death at listing Albumin at transplant Status 1A at transplant Recipient has diabetes Recipient cardiac index Center 2008 transplant volume Multiorgan transplant Death during tx hospitalization Death in 1st year Death in 2nd year Retransplant in 1st year Retransplant in 2nd year
Level Continuous (per mg/dL) Unknown Yes Unknown 0-17 18-34 50-64 65+ CVA Yes Unknown Hours Unknown In ICU Hospitalized not in ICU Continuous (per mm Hg) Unknown Yes 50-64 65+ Cardiomyopathy Congenital heart disease Other/unknown Continuous (per cm) Unknown Continuous (per kg) Unknown Black Hispanic Asian Other/unknown Applies when > 1.5 mg/dL Yes Yes Yes Yes Unknown Continous (per mg/dL) Unknown Yes Yes Continuous (per L/min/m2) Unknown Continuous (per transplant) Yes Yes Yes Yes Yes Yes
At transplant Estimate 165,448 ˚˚˚˚ 909 24,248 23,171 ˚˚ 16,628 2,594 4,881 2,173 -68,515 3,351 -216 12,401 ˚ 5,253 ˚˚˚˚ -16,561 28,118 ˚˚˚˚ 27,117 ˚˚˚˚ -49 4,894 10,184 -1,896 -2,433 -3,406 30,654 ˚˚ -180 -191 -14,582 -127 18,138 5,954 2,036 10,648 14,543 9,551 ˚˚ -5,211 12,235 ˚˚˚ -7,900 1,811 4,554 -4,183 -11,040 11,734 ˚˚˚ 2,024 994 -11,680 822 ˚˚˚˚ 19,483 ˚˚ 40,570 ˚˚˚˚ 0 0 0 0
In first year Estimate 79,183 ˚˚˚˚ -1,594 ˚˚˚ 4,970 12,418 ˚ -9,854 3,487 3,321 -79 18,972 2,319 3,725 ˚ 293 233 -8,518 -5,000 3,980 -188 ˚˚ -838 -11,756 ˚ 1,535 -282 -252 1,129 -87 -58 25,259 124 ˚ 5,194 -2,378 -4,859 5,425 -6,279 628 -14,025 -2,034 -9,954 3,033 -149 -2,330 -3,215 1,525 3,383 265 -8,453 98 ˚ 10,045 ˚ 0 23,125 ˚˚˚˚ 0 430,440 ˚˚˚˚ 0
In second year Estimate 30,984 ˚˚˚˚ 62 945 -5,337 11,362 ˚ 3,766 736 3,717 -11,041 92 884 -2,224 1,050 ˚ -2,401 -735 1,175 -58 -3,864 457 819 -1,038 -813 -25 -2,828 -77 ˚˚ 0 38 0 932 -2,247 -1,599 -3,019 2,252 -2,721 33 288 -1,199 -1,141 401 2,811 -1,100 1,627 677 116 40 4,847 0 0 16,234 ˚˚˚˚ 0 430,440 ˚˚˚˚
Econ 5.8 Predictors of heart transplant costs Predictors of costs paid by Medicare, reported in $US. Year 1 is days 1-365 posttransplant and year 2 days 366-730. Estimates for recipient sex, PRA, and BMI donor/recipient ratio are zero, and are excluded from the table. Estimates for reference categories, not shown, are zero. Reference groups: primary diagnosis, coronary artery disease; race/ethnicity, white. ****P < 0.0001. ***P < 0.001. **P < 0.01. *P < 0.05. CVA, cerebrovascular accident; ECMO, extracorporeal membrane oxygenation; PA, pulmonary artery; VAD, ventricular assist device.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
20
OPTN/SRTR 2013 Annual Data Report
lung
Econ 6.2 Rehospitalization rates among lung transplant recipients in years 1 and 2 posttransplant Econ 6.1 Medicare coverage among lung transplant recipients, 2008-2012 Coverage at the time of transplant as identified by the Medicare Beneficiary Annual Summary supplied by CMS.
Year 1 Cause of hospitalization Surgical complications Gastro-intestinal Other Other infection Respiratory infection Respiratory Genito-urinary and breast Bacteremia, viremia and septicemia Conduction disorders and dysrhythmias Immune and hematologic
Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Rehospitalizations and reasons determined from Medicare claims. Year-1 rates are based on rehospitalizations from initial discharge to 1 year later and year2 rates on rehospitalizations in the subsequent year.
% 43.0 10.0 7.4 5.9 5.4 4.5 3.7 2.9 2.6 2.4
Year 2 Cause of hospitalization Surgical complications Other infection Gastro-intestinal Other Respiratory infection Genito-urinary and breast Respiratory Bacteremia, viremia and septicemia Circulatory system Immune and hematologic
% 36.2 7.9 7.8 7.6 6.8 5.0 4.5 3.3 2.5 2.0
Econ 6.3 Top 10 causes of rehospitalization among lung transplant recipients with Medicare primary coverage, 2008-2010 Transplant recipients with Medicare as primary payer at transplant, 2008-2010. Reasons for rehospitalization determined from Medicare claims; denominator for percentages includes only rehospitalized recipients. Values for cells with 9 or fewer recipientss are suppressed.
21 economics
All recipients Age
N 2,010
Total costs ($ in thousands) Part A Part B 373,464 51,166
PPPY costs ($) Part A Part B 207,959 28,491
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
148 192 703 967
29,322 37,999 125,065 181,078
4,134 5,533 16,770 24,729
218,315 221,756 199,004 210,131
30,782 32,288 26,685 28,697
Sex
Male Female
1,216 794
223,071 150,393
30,390 20,776
207,360 208,853
28,250 28,852
Race
White Black Hispanic Asian Other/unknown
1,722 158 92 24 14
317,065 30,422 18,328 5,021 2,628
43,797 4,268 2,123 645 333
204,557 228,804 237,537 220,847 202,258
28,256 32,100 27,512 28,379 25,656
Diagnosis group
A B C D Other/unknown
822 104 179 882 23
140,166 22,349 33,034 174,624 3,292
19,695 3,296 5,059 22,581 536
188,008 253,162 200,484 224,979 155,999
26,417 37,334 30,704 29,092 25,392
Econ 6.4 Total and per person per year Medicare costs of lung transplant recipients in year 1 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 20082011. Year-1 costs include the transplant hospitalization. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
All recipients Age
N 1,154
Total costs ($ in thousands) Part A Part B 41,366 14,219
PPPY costs ($) Part A Part B 38,522 13,242
0-11 12-17 18-34 35-49 50-64 65+
˚ ˚
˚ ˚
˚ ˚
˚ ˚
˚ ˚
83 124 421 526
3,527 3,504 15,208 19,127
1,027 1,679 4,859 6,654
45,468 30,668 38,312 39,432
13,239 14,696 12,241 13,718
Sex
Male Female
703 451
22,802 18,564
8,538 5,682
34,913 44,124
13,072 13,505
Race
White Black Hispanic Asian Other/unknown
999 87 47 13
36,535 2,434 1,705 361
12,309 1,015 671 131
39,335 30,338 37,750 30,326
13,252 12,656 14,857 11,013
˚
˚
˚
˚
˚
A B C D Other/unknown
499 61 107 467 20
18,531 2,249 4,024 16,005 558
6,082 700 1,490 5,748 200
39,554 40,458 39,789 37,212 30,096
12,982 12,590 14,736 13,364 10,764
Diagnosis group
Econ 6.5 Total and per person per year Medicare costs of lung transplant recipients in year 2 posttransplant Costs for recipients with Medicare as primary payer at the time of transplant, 2008-2010. Year 2 year is from day 366 to day 730 days posttransplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units and per person per year (PPPY) costs in $ units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
lung
22
OPTN/SRTR 2013 Annual Data Report
lung All recipients Age
N 5,618
2010 Part A 186,505
Part B 46,245
2011 Part A 216,662
N 6,209
Part B 51,066
N 6,590
2012 Part A 231,328
Part B 53,901
0-11 12-17 18-34 35-49 50-64 65+
˚
˚
˚
˚
˚
˚
˚
˚
˚
17 507 1,028 2,981 1,076
134 16,603 28,375 82,479 58,805
60 4,068 7,606 22,243 12,221
16 576 1,065 3,186 1,358
111 20,266 27,586 90,277 78,186
49 4,345 7,805 23,148 15,650
13 578 1,097 3,350 1,544
383 19,728 32,655 92,950 85,505
75 4,528 8,124 23,672 17,454
Sex
Male Female
3,120 2,498
105,176 81,329
26,260 19,985
3,477 2,732
123,728 92,935
29,455 21,611
3,762 2,828
130,219 101,110
30,678 23,222
Race
White Black Hispanic Asian Other/unknown
4,895 436 209 49 29
158,613 16,032 8,921 1,688 1,251
40,305 3,356 1,940 359 284
5,378 487 244 67 33
185,963 16,570 9,908 2,843 1,379
44,566 3,712 2,011 516 260
5,667 536 272 79 36
199,569 18,070 8,552 4,126 1,011
47,149 3,765 2,026 698 264
Diagnosis group
A B C D Other/unknown
2,583 298 591 1,985 161
78,357 12,776 18,488 73,555 3,329
21,368 2,719 5,091 16,026 1,041
2,733 306 663 2,341 166
88,859 12,316 22,130 90,096 3,262
22,412 2,670 5,469 19,446 1,068
2,727 319 694 2,698 152
89,447 10,681 22,974 105,194 3,033
22,410 2,456 5,945 22,105 985
Econ 6.6 Total calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Total costs are given in $1000 units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
All recipients Age
N 5,618
2010 Part A 38,309
Part B 9,499
N 6,209
2011 Part A 40,284
Part B 9,495
N 6,590
2012 Part A 40,010
Part B 9,323
0-11 12-17 18-34 35-49 50-64 65+
˚
˚
˚
˚
˚
˚
˚
˚
˚
17 507 1,028 2,981 1,076
9,585 37,550 30,217 31,205 71,619
4,295 9,200 8,099 8,415 14,884
16 576 1,065 3,186 1,358
7,159 39,628 28,353 32,020 74,379
3,175 8,497 8,022 8,210 14,888
13 578 1,097 3,350 1,544
31,275 38,149 32,653 30,889 69,183
6,114 8,755 8,123 7,867 14,122
Sex
Male Female
3,120 2,498
39,480 36,895
9,857 9,066
3,477 2,732
41,219 39,102
9,813 9,093
3,762 2,828
39,689 40,431
9,350 9,286
Race
White Black Hispanic Asian Other/unknown
4,895 436 209 49 29
37,323 42,682 50,158 41,275 51,466
9,484 8,935 10,910 8,779 11,699
5,378 487 244 67 33
39,994 38,297 47,647 49,223 45,441
9,585 8,579 9,671 8,943 8,583
5,667 536 272 79 36
40,155 38,156 35,607 62,998 31,115
9,487 7,950 8,433 10,660 8,116
Diagnosis group
A B C D Other/unknown
2,583 298 591 1,985 161
34,537 51,804 35,808 43,649 21,971
9,418 11,026 9,860 9,510 6,872
2,733 306 663 2,341 166
37,476 45,135 37,444 45,391 20,569
9,452 9,784 9,253 9,797 6,736
2,727 319 694 2,698 152
37,033 37,081 36,787 45,554 20,970
9,278 8,525 9,520 9,573 6,813
Econ 6.7 Per person per year calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012 Costs paid by Medicare in each calendar year for recipients alive with graft function in the given year, regardless of Medicare eligibility at the time of transplant. Costs incurred after transplant failure are excluded. Per person per year (PPPY) costs are given in $ units. Values for cells with 9 or fewer recipients are suppressed. A, obstructive lung disease; B, pulmonary vascular disease; C, cystic fibrosis; D, restrictive lung disease.
23 economics
List of Figures/Tables kidney Econ 1.1 Medicare coverage among kidney transplant recipients, 2008-2012 Econ 1.2 Rehospitalization rates among kidney transplant recipients in years 1 and 2 posttransplant Econ 1.3 Top ten causes of rehospitalization among kidney transplant recipients with Medicare primary coverage, 20082010 Econ 1.4 Total and per person per year Medicare costs of kidney transplant recipients in year 1 posttransplant Econ 1.5 Total and per person per year Medicare costs of kidney transplant recipients in year 2 posttransplant Econ 1.6 Total calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012 Econ 1.7 Per person per year calendar-year Medicare costs of kidney transplant recipients, 2010, 2011, and 2012
pancreas Econ 2.1 Medicare coverage among pancreas transplant recipients, 2008-2012 Econ 2.2 Rehospitalization rates among pancreas transplant recipients in years 1 and 2 posttransplant Econ 2.3 Top 10 causes of rehospitalization among pancreas transplant recipients with Medicare primary coverage, 2008-2010 Econ 2.4 Total and per person per year Medicare costs of pancreas transplant recipients in year 1 posttransplant Econ 2.5 Total and per person per year Medicare costs of pancreas transplant recipients in year 2 posttransplant Econ 2.6 Total calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012 Econ 2.7 Per person per year calendar-year Medicare costs of pancreas transplant recipients, 2010, 2011, and 2012
liver Econ 3.1 Medicare coverage among liver transplant recipients, 2008-2012 Econ 3.2 Rehospitalization rates among liver transplant recipients in years 1 and 2 posttransplant Econ 3.3 Top 10 causes of rehospitalization among liver transplant recipients with Medicare primary coverage, 20082010 Econ 3.4 Total and per person per year Medicare costs of liver transplant recipients in year 1 posttransplant Econ 3.5 Total and per person per year Medicare costs of liver transplant recipients in year 2 posttransplant Econ 3.6 Total calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012 Econ 3.7 Per person per year calendar-year Medicare costs of liver transplant recipients, 2010, 2011, and 2012
intestine Econ 4.1 Medicare coverage among intestine transplant recipients, 2008-2012 Econ 4.2 Rehospitalization rates among intestine transplant recipients in years 1 and 2 posttransplant Econ 4.3 Top 10 causes of rehospitalization among intestine transplant recipients with Medicare primary coverage, 2008-2010 Econ 4.4 Total and per person per year Medicare costs of intestine transplant recipients in year 1 posttransplant Econ 4.5 Total calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012 Econ 4.6 Per person per year calendar-year Medicare costs of intestine transplant recipients, 2010, 2011, and 2012
heart Econ 5.1 Medicare coverage among heart transplant recipients, 2008-2012 Econ 5.2 Rehospitalization rates among heart transplant recipients in years 1 and 2 posttransplant Econ 5.3 Top 10 causes of rehospitalization among heart transplant recipients with Medicare primary coverage, 20082010 Econ 5.4 Total and per person per year Medicare costs among heart transplant recipients in year 1 posttransplant Econ 5.5 Total and per person per year Medicare costs among heart transplant recipients in year 2 posttransplant Econ 5.6 Total calendar-year Medicare costs of heart transplant recipients, 2010, 2011, and 2012 Econ 5.7 Per person per year calendar-year Medicare costs for heart transplant recipients, 2010, 2011, and 2012
data behind the figures can be downloaded from our website, at srtr.tranplant.hrsa.gov
24
OPTN/SRTR 2013 Annual Data Report
Econ 5.8 Predictors of heart transplant costs
lung Econ 6.1 Medicare coverage among lung transplant recipients, 2008-2012 Econ 6.2 Rehospitalization rates among lung transplant recipients in years 1 and 2 posttransplant Econ 6.3 Top 10 causes of rehospitalization among lung transplant recipients with Medicare primary coverage, 20082010 Econ 6.4 Total and per person per year Medicare costs of lung transplant recipients in year 1 posttransplant Econ 6.5 Total and per person per year Medicare costs of lung transplant recipients in year 2 posttransplant Econ 6.6 Total calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012 Econ 6.7 Per person per year calendar-year Medicare costs of lung transplant recipients, 2010, 2011, and 2012
