The financial burden after liver transplantation is significant among commercially insured adults: A large US National Cohort.

Autor:	Lieber SR; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Jiang Y; Department of Statistical Science, Duke University, Durham, North Carolina, USA., Jones AR; Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Gowda P; Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Ufere NN; Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Patel MS; Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Gurley T; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Noriega Ramirez A; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Ngo VM; Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Olumesi MC; Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Trudeau RE; Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Marrero J; Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Craddock Lee SJ; Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA., Mufti A; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Singal AG; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., VanWagner LB; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA.
Jazyk:	angličtina
Zdroj:	Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2024 Sep 01; Vol. 30 (9), pp. 932-944. Date of Electronic Publication: 2023 Dec 18.
DOI:	10.1097/LVT.0000000000000320
Abstrakt:	Liver transplantation (LT) is lifesaving for patients with cirrhosis; however, the resultant financial burden to patients has not been well characterized. We aimed to provide a nationally representative portrayal of patient financial burden after LT. Adult recipients of LT from 2006 to 2021 were identified using IQVIA PharMetrics® Plus for Academics-a large nationally representative claims database of commercially insured Americans. Patient financial liability (ie, what patients owe) was estimated using the difference between allowed and paid costs for adjudicated medical/pharmacy claims. Descriptive statistics were provided stratified by the financial liability group within 1 year after LT. Multivariable logistic regression modeling identified factors associated with high/extreme liability adjusting for covariates. Potential indirect costs of post-LT care were estimated based on hourly wages lost for care. Among 1412 recipients of LT, financial liability was heterogeneous-~3% had no liability and 21% had extreme liability > $10K for 1-year post-LT care; most (69%) paid between $1 and 10K, with 48% having liability >$5K. Factors associated with >$5K liability included older age, insurance/enrollment type, US region, history of HCC, and simultaneous liver-kidney transplant (for liability >$10K). Medication costs comprised ~30% of outpatient financial liability. Potential indirect costs from wages lost were $2,201-$6,073 per person, depending on an hourly wage. In a large national cohort of commercially insured recipients of LT, financial liability was highly variable across sociodemographic and clinical characteristics; nearly 1 out of 2 recipients of LT owed >$5K for 1 year of post-LT care. Transplant programs should help patients anticipate potential costs and identify vulnerable populations who would benefit from enhanced financial counseling. (Copyright © 2023 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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