Table 3.
Multivariate regression estimates of adjusted cost drivers at transplant hospitalization and one, two, and three years in Medicare-insured transplant recipients from 1995–2004 (in US dollars).
| Variable | Transplant hospitalization† | One year post transplant† | Two years post transplant† | Three years post transplant† |
|---|---|---|---|---|
| Base Cost | 33173 (31410 – 34936)* | 57337 (52327 – 62346) * | 66255 (59137 – 73373) * | 76000 (66675 – 85326) * |
| DGF – dialysis 1st week only | 2727 (2323 – 3131) * | 6476 (5299 – 7652) * | 7246 (5537 – 8954) * | 8742 (6456 – 11029) * |
| DGF – dialysis in 2 periods‡ | 1219 (442 – 1997) * | 17070 (14794 – 19346) * | 18036 (14777 – 21295) * | 21481 (17107 – 25855) * |
| DGF – dialysis in 2+ periods‡ | 2461 (1379 – 3544) * | 27606 (24497 – 30716) * | 33675 (29221 – 38129) * | 39855 (33856 – 45855) * |
| No DGF – some dialysis | 1762 (868 – 2657) * | 20013 (17448 – 22578) * | 21984 (18408 – 25560) * | 24846 (20265 – 29426) * |
| No DGF – no dialysis | Reference | Reference | Reference | Reference |
| Recipient characteristics | ||||
| Female | −226 (−599 – 146) | −93 (−1168 – 983) | 1207 (−334 – 2748) | 3086 (1053 – 5120) * |
| Race | ||||
| African American | 1318 (879 – 1757) * | 1969 (690 – 3249) * | 4532 (2691 – 6374) * | 7543 (5112 – 9974) * |
| White | Reference | Reference | Reference | Reference |
| Other | 391 (−354 – 1136) | −5426 (−7624 – −3228) * | −9224 (−12397 – −6052) * | −13901 (−18094 – −9708) * |
| Age (years) | ||||
| 18–30 | Reference | Reference | Reference | Reference |
| 31–44 | −37 (−722 – 648) | 192 (−1764 – 2148) | 636 (−2134 – 3405) | 329 (−3254 – 3911) |
| 45–59 | −597 (−1273 – 79) | 976 (−960 – 2911) | 1449 (−1298 – 4197) | 620 (−2943 – 4182) |
| ≥ 60 | −291 (−1010 – 428) | 3932 (1869 – 5996) * | 4916 (1974 – 7859) * | 3835 (−4 – 7675) |
| BMI category (kg/m2) | ||||
| < 10 or Missing | −289 (−769 – 191) | 13 (−1358 – 1385) | 474 (−1462 – 2411) | 1325 (−1176 – 3825) |
| ≥10 to <25 | Reference | Reference | Reference | Reference |
| ≥ 25 to <30 | −951 (−1421 – −481) * | −2122 (−3485 – −759) * | −1401 (−3370 – 568) | −2438 (−5071 – 196) |
| ≥ 30 | −1037 (−1558 – −516) * | 266 (−1257 – 1790) | 1050 (−1167 – 3267) | 2272 (−720 – 5264) |
| Primary cause of ESRD | ||||
| Diabetes mellitus | 2535 (1910 – 3160) * | 13085 (11248 – 14923) * | 22012 (19388 – 24636) * | 28111 (24658 – 31563) * |
| Hypertension | 1343 (706 – 1980) * | 390 (−1512 – 2291) | 1685 (−1042 – 4412) | 1715 (−1885 – 5315) |
| Glomerulonephritis | −480 (−1125 – 164) | −4148 (−6054 – −2241) * | −5515 (−8233 – −2798) * | −7745 (−11317 – −4173) * |
| PKD | 126 (−704 – 956) | −3593 (−6024 – −1161) * | −5395 (−8883 – −1908) * | −9005 (−13620 – −4389) * |
| Other | Reference | Reference | Reference | Reference |
| Unknown | 1385 (672 – 2098) * | 577 (−1525 – 2680) | 1267 (−1752 – 4286) | 846 (−3120 – 4812) |
| Hispanic | 507 (−72 – 1086) | 3361 (1745 – 4977) * | 5217 (2909 – 7525) * | 6181 (3123 – 9239) * |
| PVD | 233 (−668 – 1133) | 6601 (4026 – 9176) * | 11829 (8152 – 15505) * | 14462 (9646 – 19278) * |
| Pre-Transplant Dialysis | ||||
| None (pre-emptive) | 1359 (436 – 2283) * | 6174 (3503 – 8845) * | 6680 (2848 – 10511) * | 7769 (2669 – 12869) * |
| 0–12 months | Reference | Reference | Reference | Reference |
| 13–24 months | −1354 (−2111 – −596) * | −2315 (−4464 – −167) * | −2626 (−5650 – 398) | −2150 (−6038 – 1737) |
| 25–60 months | −667 (−1337 – 3) | −858 (−2760 – 1045) | −1989 (−4680 – 702) | −3123 (−6593 – 348) |
| More than 60 months | 398 (−352 – 1147) | 3270 (1122 – 5417) * | 3855 (789 – 6921) * | 4895 (885 – 8904) * |
| Donor Characteristics | ||||
| Gender | ||||
| Female | −392 (−767 – −18) * | −402 (−1487 – 683) | −229 (−1787 – 1329) | −28 (−2087 – 2031) |
| Race | ||||
| African American | 698 (143 – 1253) * | 2977 (1368 – 4585) * | 4979 (2661 – 7298) * | 8448 (5370 – 11527) * |
| White | Reference | Reference | Reference | Reference |
| Other | 857 (−77 – 1791) | −1 (−2880 – 2879) | 303 (−3872 – 4477) | 5889 (386 – 11393) * |
| Age (years) | ||||
| ≤ 18 | 125 (−436 – 686) | 561 (−1051 – 2172) | 742 (−1549 – 3032) | 1729 (−1267 – 4725) |
| 19–30 | Reference | Reference | Reference | Reference |
| 31–44 | 725 (215 – 1236) * | 1889 (415 – 3363) * | 1495 (−623 – 3612) | 2639 (−157 – 5434) |
| 45–59 | 998 (458 – 1538) * | 3703 (2135 – 5271) * | 5346 (3076 – 7616) * | 7526 (4483 – 10569) * |
| ≥ 60 | 2127 (1130 – 3124) * | 9117 (6215 – 12019) * | 13809 (9622 – 17997) * | 16626 (11016 – 22236) * |
| BMI category (kg/m2) | ||||
| < 10 or Missing | 499 (−484 – 1481) | −82 (−2805 – 2642) | 301 (−3401 – 4004) | −1320 (−5896 – 3256) |
| ≥10 to <25 | Reference | Reference | Reference | Reference |
| ≥ 25 to <30 | −22 (−446 – 402) | −543 (−1773 – 686) | −797 (−2569 – 974) | −337 (−2684 – 2009) |
| ≥ 30 | 148 (−365 – 661) | −192 (−1686 – 1302) | −1636 (−3797 – 525) | −2869 (−5766 – 27) |
| Death due to stroke | 361 (−73 – 795) | 2443 (1184 – 3702) * | 3881 (2064 – 5697) * | 5822 (3401 – 8244) * |
| Terminal Creatinine ≥ 1.5 | 967 (458 – 1477) * | 586 (−891 – 2063) | 1036 (−1089 – 3161) | 1796 (−1008 – 4600) |
| Hypertension history | 609 (79 – 1139) * | 2759 (1218 – 4300) * | 4005 (1774 – 6236) * | 5767 (2803 – 8732) * |
| Diabetes | −123 (−1050 – 804) | 376 (−2326 – 3079) | 1825 (−2180 – 5831) | 4006 (−1447 – 9460) |
| Transplant Factors | ||||
| Donor Type | ||||
| SCD | Reference | Reference | Reference | Reference |
| ECD | 750 (−98 – 1598) | 2069 (−401 – 4538) | 3147 (−418 – 6711) | 4494 (−247 – 9235) |
| DCD | 1969 (831 – 3107) * | 4453 (947 – 7959) * | 5079 (−328 – 10486) | 4293 (−3404 – 11989) |
| Peak PRA % | ||||
| 0–10% | 776 (197 – 1355) * | 2547 (889 – 4205) * | 3842 (1494 – 6190) * | 4924 (1875 – 7972) * |
| 11–30% | Reference | Reference | Reference | Reference |
| >30% | 2026 (1487 – 2566) * | 6482 (4927 – 8037) * | 10917 (8684 – 13149) * | 12567 (9614 – 15520) * |
| Unknown | 2950 (2054 – 3847) * | 7985 (4395 – 11576) * | 6113 (750 – 11476) * | 4231 (−2866 – 11328) |
| HLA Mismatches | ||||
| 0 HLA mismatches | Reference | Reference | Reference | Reference |
| 1 HLA mismatches | 404 (−508 – 1316) | 452 (−2161 – 3065) | −196 (−3910 – 3517) | 2010 (−2888 – 6908) |
| 2 HLA mismatches | −326 (−1126 – 474) | 684 (−1608 – 2976) | 1147 (−2123 – 4417) | 1799 (−2517 – 6116) |
| 3 HLA mismatches | −387 (−1097 – 322) | 1106 (−944 – 3155) | 2319 (−620 – 5258) | 2181 (−1706 – 6067) |
| 4 HLA mismatches | 391 (−308 – 1089) | 2600 (573 – 4628) * | 3901 (979 – 6824) * | 4697 (819 – 8576) * |
| 5 HLA mismatches | 976 (243 – 1709) * | 5956 (3822 – 8090) * | 8719 (5628 – 11810) * | 10145 (6035 – 14254) * |
| 6 HLA mismatches | 1606 (711 – 2502) * | 6829 (4229 – 9429) * | 8405 (4633 – 12178) * | 10601 (5541 – 15660) * |
| Unknown | 2502 (1163 – 3842) * | 7659 (3831 – 11487) * | 13312 (7932 – 18691) * | 16293 (9370 – 23217) * |
| CMV sero-pairing | ||||
| Donor − / Recipient − | Reference | Reference | Reference | Reference |
| Donor − / Recipient + | −325 (−961 – 311) | −172 (−2005 – 1662) | −86 (−2706 – 2534) | 2471 (−986 – 5928) |
| Donor + / Recipient − | 43 (−621 – 706) | 6119 (4209 – 8029) * | 8062 (5332 – 10792) * | 10371 (6784 – 13959) * |
| Donor + / Recipient + | −98 (−693 – 497) | 1658 (−58 – 3374) | 3020 (568 – 5473) * | 5880 (2653 – 9108) * |
| Unknown | 64 (−722 – 849) | 2877 (609 – 5145) * | 5162 (1941 – 8383) * | 9235 (5019 – 13450) * |
| Cold-time | ||||
| 0 – 14 hours | Reference | Reference | Reference | Reference |
| 15 – 19 hours | −325 (−817 – 167) | −1125 (−2553 – 303) | −1584 (−3637 – 469) | −794 (−3513 – 1924) |
| 20 – 25 hours | 890 (386 – 1394) * | 648 (−810 – 2106) | 704 (−1389 – 2797) | 617 (−2143 – 3377) |
| 26+ hours | 4037 (3501 – 4573) * | 5325 (3784 – 6865) * | 5649 (3455 – 7844) * | 4429 (1550 – 7308) * |
| Unknown | 2978 (2319 – 3637) * | 5036 (3103 – 6970) * | 4750 (1896 – 7605) * | 6270 (2359 – 10181) * |
| Year | ||||
| 1995 ** | Reference | Reference | Reference | Reference |
| 1996 | −1458 (−2262 – −654) * | −2277 (−4502 – −53) * | −1673 (−4685 – 1338) | −1819 (−5519 – 1882) |
| 1997 | −4418 (−5192 – −3643) * | −6521 (−8664 – −4379) * | −8239 (−11141 – −5336) * | −9645 (−13213 – −6077) * |
| 1998 | −5952 (−6736 – −5168) * | −11433 (−13602 – −9264) * | −12815 (−15755 – −9875) * | −13715 (−17332 – −10098) * |
| 1999 | −7277 (−8068 – −6485) * | −13947 (−16138 – −11757) * | −14618 (−17588 – −11647) * | −15831 (−19488 – −12173) * |
| 2000 | −8297 (−9093 – −7500) * | −11218 (−13426 – −9010) * | −10232 (−13231 – −7233) * | −10798 (−14500 – −7096) * |
| 2001 | −9399 (−10188 – −8609) * | −13744 (−15932 – −11555) * | −14396 (−17371 – −11421) * | −15758 (−19434 – −12081) * |
| 2002 | −11555 (−12348 – −10761) * | −18870 (−21070 – −16670) * | −19225 (−22216 – −16233) * | − |
| 2003 | −13837 (−14632 – −13043) * | −23061 (−25267 – −20854) * | 12991 (3764 – 22219) * | − |
| 2004 | −15699 (−16600 – −14798) * | 15414 (3619 – 27208) * | −7226 (−23593 – 9140) | − |
Costs adjusted to 2004 as the base year
†
Coefficient Estimates (95% CI).
*
P-value < 0.05.
‡
Periods of early dialysis were first week, the second week, weeks 3 or 4, the second month and the third month post-transplant
**
All costs were adjusted for inflation with the medical component of the consumer price index using the year 2000 as the base year.