Table 5.
Direct variable cost of index hospitalization.
| A | B | C | P-value | ||||
|---|---|---|---|---|---|---|---|
| Service | SCS SCD N = 45 |
SCS ECD N = 21 |
EVLP N = 22 |
KW | A vs B | A vs C | B vs C |
| A. Direct variable costs | |||||||
| Intermediate Care | 11798 (8489, 16841), [0, 124796] | 14452 (9928, 19944), [7467, 79968] | 12673 (9297, 22165), [0, 96356] | 0.47 | |||
| Intensive Care | 7914 (4290, 22739), [2008, 281655] | 6436 (4554, 21840), [3792, 85179] | 12980 (7294, 51059), [2097, 409759] | 0.26 | |||
| Pharmacy | 20989 (15668, 40948), [11251, 364563] | 24989 (18666, 44614), [15534, 80685] | 40900 (21564, 75751), [6849, 279335] | 0.07 | |||
| Surgical | 15852 (13454, 21244), [10017, 136856] | 16420 (11961, 25419), [9798, 42443] | 19170 (13101, 33029), [10488, 97692] | 0.60 | |||
| Cardiology | 258 (225, 461), [37, 6031] | 301 (261, 479), [202, 1543] | 355 (228, 881), [60, 3042] | 0.43 | |||
| Respiratory Care | 5437 (3001, 18170), [863, 193249] | 6407 (2774, 12186), [1228, 42835] | 10237 (3580, 27779), [912, 114383] | 0.48 | |||
| PT/OT/Speech | 1453 (1042, 3134), [690, 33274] | 1758 (1446, 2538), [1167, 13246] | 2482 (1470, 6192), [656, 22548] | 0.11 | |||
| Laboratory | 4278 (3548, 7345), [2204, 40553] | 4797 (3799, 6882), [2835, 17243] | 5626 (3523, 10084), [2980, 33630] | 0.40 | |||
| Radiology | 1178 (541, 2709), [230, 22389] | 1188 (683, 1568), [214, 7385] | 1709 (1003, 4430), [84, 15435] | 0.20 | |||
| Blood Bank | 1139 (359, 5082), [35, 55621] | 1146 (843, 3748), [66, 8976] | 2331 (1443, 3936), [284, 42432] | 0.16 | |||
| Clinic Services | 0 (0, 0), [0, 765] | 0 (0, 0), [0, 129] | 0 (0, 0), [0, 407] | 0.96 | |||
| Medical Supplies | 752 (522, 1317), [187, 4443] | 795 (511, 1705), [95, 3083] | 1246 (710, 2861), [223, 15172] | 0.10 | |||
| Emergency Room | 0 (0, 0), [0, 381] | 0 (0, 0), [0, 381] | 0 (0, 0), [0, 279] | >0.99 | |||
| Other Diagnostics | 428 (207, 998), [0, 44819] | 857 (428, 1396), [0, 12877] | 1386 (701, 4362), [0, 46226] | 0.003 | 0.20 | 0.003 | 0.69 |
| TOTALa | 154709 (137890, 218180), [104071, 1372733] | 168334 (151102, 209383), [129978, 418510] | 200404 (161966, 362143), [104032, 940844] | 0.11 | |||
| B. Organ acquisition costs | |||||||
| Organ Acquisitionb | 79135 (78915, 81547), [56030, 83370] | 79135 (79135, 83370), [71130, 83370] | 81547 (78915, 83370), [64048, 89955] | 0.38 | |||
| Adjusted Organ Acquisitionc | 77201 (76981, 79613), [54096, 81436] | 77201 (77201, 81436), [69196, 81436] | 132091 (98955, 134613), [82114, 143021] | <0.0001 | >0.99 | <0.0001 | <0.0001 |
Median (interquartile range), [full range].
ECD, extended-criteria donor. EVLP, ex-vivo lung perfusion. KW, Kruskal-Wallis. OT, occupational therapy. PT, physical therapy. SCD, standard-criteria donor. SCS, static cold storage.
Total direct variable costs did not include organ acquisition costs (see footnote b).
Organ acquisition was defined by our institution as a variable cost, however these values represented a standardized fee that varied annually; accordingly, reported organ acquisition costs did not include disposable and device-related costs specific to EVLP and were not included in the calculation of total direct variable costs.
To understand how use of EVLP actually impacts the cost of organ acquisition, reported organ acquisition costs were adjusted to allocate all disposable and device-related costs specific to EVLP entirely to recipients of EVLP lungs. Cost adjustments for individual patients were based on the specific EVLP platform used (Lung-Bioengineering, XVIVO Perfusion System, TransMedics Organ Care System).