What are the short-term annual cost savings associated with kidney transplantation?
Abstract Background Kidney transplantation (KT) is often reported in the literature as associated with cost savings. However, existing studies differ in their choice of comparator, follow-up period, and the study perspective. Also, there may be unobservable heterogeneity in health care costs in the...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-05-01
|
| Series: | Cost Effectiveness and Resource Allocation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12962-022-00355-2 |
| _version_ | 1818007227978481664 |
|---|---|
| author | Prosper Koto Karthik Tennankore Amanda Vinson Kristina Krmpotic Matthew J. Weiss Chris Theriault Stephen Beed |
| author_facet | Prosper Koto Karthik Tennankore Amanda Vinson Kristina Krmpotic Matthew J. Weiss Chris Theriault Stephen Beed |
| author_sort | Prosper Koto |
| collection | DOAJ |
| description | Abstract Background Kidney transplantation (KT) is often reported in the literature as associated with cost savings. However, existing studies differ in their choice of comparator, follow-up period, and the study perspective. Also, there may be unobservable heterogeneity in health care costs in the patient population which may divide the population into groups with differences in cost distributions. This study estimates the cost savings associated with KT from a payer perspective and identifies and characterizes both high and low patient cost groups. Method The current study was a population-based retrospective before-and-after study. The timespan involved at most three years before and after KT. The sample included end-stage kidney disease patients in Nova Scotia, a province in Canada, who had a single KT between January 1, 2011, and December 31, 2018. Each patient served as their control. The primary outcome measure was total annual health care costs. We estimated cost savings using unadjusted and adjusted models, stratifying the analyses by donor type. We quantified the uncertainty around the estimates using non-parametric and parametric bootstrapping. We also used finite mixture models to identify data-driven cost groups based on patients’ pre-transplantation annual inpatient costs. Results The mean annual cost savings per patient associated with KT was $19,589 (95% CI: $14,013, $23,397). KT was associated with a 24–29% decrease in mean annual health care costs per patient compared with the annual costs before KT. We identified and characterized patients in three cost groups made of 2.9% in low-cost (LC), 51.8% in medium-cost (MC) and 45.3% in high-cost (HC). Cost group membership did not change after KT. Comparing costs in each group before and after KT, we found that KT was associated with 17% mean annual cost reductions for the LC group, 24% for the MC group and 26% for the HC group. The HC group included patients more likely to have a higher comorbidity burden (Charlson comorbidity index ≥ 3). Conclusions KT was associated with reductions in annual health care costs in the short term, even after accounting for costs incurred during KT. |
| first_indexed | 2024-04-14T05:13:00Z |
| format | Article |
| id | doaj.art-d2907eb1be6d45b5a97e5569f8f92dd6 |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-04-14T05:13:00Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-d2907eb1be6d45b5a97e5569f8f92dd62022-12-22T02:10:29ZengBMCCost Effectiveness and Resource Allocation1478-75472022-05-0120111010.1186/s12962-022-00355-2What are the short-term annual cost savings associated with kidney transplantation?Prosper Koto0Karthik Tennankore1Amanda Vinson2Kristina Krmpotic3Matthew J. Weiss4Chris Theriault5Stephen Beed6Research Methods Unit, Nova Scotia HealthDepartment of Medicine (Division of Nephrology), Dalhousie UniversityDepartment of Medicine (Division of Nephrology), Dalhousie UniversityDepartment of Critical Care, Dalhousie UniversityCentre Mère-Enfant Soleil du CHU de Québec, Transplant QuébecResearch Methods Unit, Nova Scotia HealthDepartment of Critical Care, Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie UniversityAbstract Background Kidney transplantation (KT) is often reported in the literature as associated with cost savings. However, existing studies differ in their choice of comparator, follow-up period, and the study perspective. Also, there may be unobservable heterogeneity in health care costs in the patient population which may divide the population into groups with differences in cost distributions. This study estimates the cost savings associated with KT from a payer perspective and identifies and characterizes both high and low patient cost groups. Method The current study was a population-based retrospective before-and-after study. The timespan involved at most three years before and after KT. The sample included end-stage kidney disease patients in Nova Scotia, a province in Canada, who had a single KT between January 1, 2011, and December 31, 2018. Each patient served as their control. The primary outcome measure was total annual health care costs. We estimated cost savings using unadjusted and adjusted models, stratifying the analyses by donor type. We quantified the uncertainty around the estimates using non-parametric and parametric bootstrapping. We also used finite mixture models to identify data-driven cost groups based on patients’ pre-transplantation annual inpatient costs. Results The mean annual cost savings per patient associated with KT was $19,589 (95% CI: $14,013, $23,397). KT was associated with a 24–29% decrease in mean annual health care costs per patient compared with the annual costs before KT. We identified and characterized patients in three cost groups made of 2.9% in low-cost (LC), 51.8% in medium-cost (MC) and 45.3% in high-cost (HC). Cost group membership did not change after KT. Comparing costs in each group before and after KT, we found that KT was associated with 17% mean annual cost reductions for the LC group, 24% for the MC group and 26% for the HC group. The HC group included patients more likely to have a higher comorbidity burden (Charlson comorbidity index ≥ 3). Conclusions KT was associated with reductions in annual health care costs in the short term, even after accounting for costs incurred during KT.https://doi.org/10.1186/s12962-022-00355-2Kidney transplantationHigh-costCost savingsCost-groupFinite mixture model |
| spellingShingle | Prosper Koto Karthik Tennankore Amanda Vinson Kristina Krmpotic Matthew J. Weiss Chris Theriault Stephen Beed What are the short-term annual cost savings associated with kidney transplantation? Cost Effectiveness and Resource Allocation Kidney transplantation High-cost Cost savings Cost-group Finite mixture model |
| title | What are the short-term annual cost savings associated with kidney transplantation? |
| title_full | What are the short-term annual cost savings associated with kidney transplantation? |
| title_fullStr | What are the short-term annual cost savings associated with kidney transplantation? |
| title_full_unstemmed | What are the short-term annual cost savings associated with kidney transplantation? |
| title_short | What are the short-term annual cost savings associated with kidney transplantation? |
| title_sort | what are the short term annual cost savings associated with kidney transplantation |
| topic | Kidney transplantation High-cost Cost savings Cost-group Finite mixture model |
| url | https://doi.org/10.1186/s12962-022-00355-2 |
| work_keys_str_mv | AT prosperkoto whataretheshorttermannualcostsavingsassociatedwithkidneytransplantation AT karthiktennankore whataretheshorttermannualcostsavingsassociatedwithkidneytransplantation AT amandavinson whataretheshorttermannualcostsavingsassociatedwithkidneytransplantation AT kristinakrmpotic whataretheshorttermannualcostsavingsassociatedwithkidneytransplantation AT matthewjweiss whataretheshorttermannualcostsavingsassociatedwithkidneytransplantation AT christheriault whataretheshorttermannualcostsavingsassociatedwithkidneytransplantation AT stephenbeed whataretheshorttermannualcostsavingsassociatedwithkidneytransplantation |