The cost implications of first anniversary renal function after living, standard criteria deceased and expanded criteria deceased donor kidney transplantation

Abstract

Objectives:

To quantify relationships of post-transplant renal function with healthcare costs after kidney transplantation.

Methods:

Clinical and billing records for Medicare-insured kidney transplant recipients (1995–2003) were drawn from the US Renal Data System. Estimated glomerular filtration rate (eGFR) at 1-year post-transplant was computed with the abbreviated Modification of Diet in Renal Disease equation. Associations of eGFR with total Medicare payments in the second and third post-transplant years were examined by multivariate non-linear regression with spline forms. Adjustment covariates were drawn from the survival prediction model developed by the UNOS Kidney Allocation Review Committee.

Results:

The sample comprised 7103 living donor (LD), 22,110 standard criteria deceased (SCD), and 2594 expanded criteria deceased (ECD) donor transplant recipients. Regardless of donor type, lower 1-year eGFR was associated with significantly increased expenditures during the second and the third years post-transplant. Marginal costs began to increase as eGFR fell below 45 mL/min/1.73 m² and rose in an accelerating manner. Compared to a reference eGFR of 75 mL/min/1.73 m², 1-year eGFR of 20 ml/min/1.73 m² in SCD recipients was associated with ∼ $17,500 and $18,200 higher adjusted payments in the second and third post-transplant years, respectively. Patterns were similar among recipients of LD and ECD transplants.

Limitations:

The study sample was limited to Medicare beneficiaries who survived with allograft function to the first transplant anniversary, which may limit generalizability of the findings. eGFR is a surrogate measure of renal function. The design is retrospective and changes in post-transplant management may alter long-term cost implication of renal function.

Conclusions:

Decreased renal function is significantly associated with higher healthcare expenditures following kidney transplantation. Post-transplant eGFR may be a useful metric for discriminating the economic impact of care strategies that differentially affect renal function.

Keywords::

• Billing claims
• Glomerular filtration rate
• Healthcare costs
• Kidney transplantation
• Medicare

Transparency

Declaration of funding

Support for data research staff time was provided by a grant from Bristol-Myers Squibb. The manuscript does not include discussion of any pharmaceutical product, other healthcare product, or off-label use of medications. The analyses, interpretation, medical writing, and reporting of these data are the responsibility of the authors. The roles of the authors in this work are as follows: M.A.S. participated in study design, data analysis, and writing of the paper. A.G., D.A., G.L., and K.L.L. participated in study design, interpretation, and writing of the paper. All authors agreed to publish the paper.

Declaration of financial/other relationships

M.A.S., A.G., K.L., and D.A. have disclosed that they received support from a grant from Bristol-Myers Squibb. G.L. is an employee of Bristol-Myers Squibb.

Acknowledgments

The data reported here have been supplied by the US Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government.