The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients

S. E. Gentry; E. K.H. Chow; N. Dzebisashvili; M. A. Schnitzler; K. L. Lentine; C. E. Wickliffe; E. Shteyn; J. Pyke; A. Israni; B. Kasiske; D. L. Segev; David A. Axelrod

doi:10.1111/ajt.13569

The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients

S. E. Gentry, E. K.H. Chow, N. Dzebisashvili, M. A. Schnitzler, K. L. Lentine, C. E. Wickliffe, E. Shteyn, J. Pyke, A. Israni, B. Kasiske, D. L. Segev, David A. Axelrod

Medicine - Renal and Hypertension Division

Research output: Contribution to journal › Article › peer-review

27 Scopus citations

Abstract

Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29 267; regional sharing, 29 005; eight districts, 29 034; four districts, 28 265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638 million to $1506 million, p < 0.001), transplant episode ($5607 million to $5569 million, p < 0.03) and posttransplant care ($479 million to $488 million, p < 0.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11 874 per patient, p < 0.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.

Original language	English (US)
Pages (from-to)	583-593
Number of pages	11
Journal	American Journal of Transplantation
Volume	16
Issue number	2
DOIs	https://doi.org/10.1111/ajt.13569
State	Published - Feb 1 2016

Bibliographical note

Funding Information:
The study was approved by the Dartmouth College Committee for the Protection of Human Subjects, the data oversight committee of the Organ Procurement and Transplantation Network (OPTN) and the Health Resources and Services Administration. This work was supported by a contract from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation (HHSH250201000018C). The work was also supported by an American Recovery and Reinvestment Act grant from the National Institute of Diabetes and Digestive and Kidney Diseases (RC1 1RC1DK086450-01). The data reported were supplied by the Minneapolis Medical Research Foundation, as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donors, waitlisted candidates and transplant recipients in the United States, submitted by the members of OPTN.

Publisher Copyright:
Copyright © 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Keywords

Sharing (UNOS)
United Network for Organ
business
economics
ethics and public policy
health services and outcomes research
hepatology
liver disease
liver transplantation
management
organ allocation
organ procurement and allocation

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Gentry, S. E., Chow, E. K. H., Dzebisashvili, N., Schnitzler, M. A., Lentine, K. L., Wickliffe, C. E., Shteyn, E., Pyke, J., Israni, A., Kasiske, B., Segev, D. L., & Axelrod, D. A. (2016). The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients. American Journal of Transplantation, 16(2), 583-593. https://doi.org/10.1111/ajt.13569

Gentry, SE, Chow, EKH, Dzebisashvili, N, Schnitzler, MA, Lentine, KL, Wickliffe, CE, Shteyn, E, Pyke, J, Israni, A, Kasiske, B, Segev, DL & Axelrod, DA 2016, 'The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients', American Journal of Transplantation, vol. 16, no. 2, pp. 583-593. https://doi.org/10.1111/ajt.13569

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title = "The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients",

abstract = "Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29 267; regional sharing, 29 005; eight districts, 29 034; four districts, 28 265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638 million to $1506 million, p < 0.001), transplant episode ($5607 million to $5569 million, p < 0.03) and posttransplant care ($479 million to $488 million, p < 0.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11 874 per patient, p < 0.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.",

keywords = "Sharing (UNOS), United Network for Organ, business, economics, ethics and public policy, health services and outcomes research, hepatology, liver disease, liver transplantation, management, organ allocation, organ procurement and allocation",

author = "Gentry, {S. E.} and Chow, {E. K.H.} and N. Dzebisashvili and Schnitzler, {M. A.} and Lentine, {K. L.} and Wickliffe, {C. E.} and E. Shteyn and J. Pyke and A. Israni and B. Kasiske and Segev, {D. L.} and Axelrod, {David A.}",

note = "Funding Information: The study was approved by the Dartmouth College Committee for the Protection of Human Subjects, the data oversight committee of the Organ Procurement and Transplantation Network (OPTN) and the Health Resources and Services Administration. This work was supported by a contract from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation (HHSH250201000018C). The work was also supported by an American Recovery and Reinvestment Act grant from the National Institute of Diabetes and Digestive and Kidney Diseases (RC1 1RC1DK086450-01). The data reported were supplied by the Minneapolis Medical Research Foundation, as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donors, waitlisted candidates and transplant recipients in the United States, submitted by the members of OPTN. Publisher Copyright: Copyright {\textcopyright} 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.",

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AU - Dzebisashvili, N.

AU - Schnitzler, M. A.

AU - Lentine, K. L.

AU - Wickliffe, C. E.

AU - Shteyn, E.

AU - Pyke, J.

AU - Israni, A.

AU - Kasiske, B.

AU - Segev, D. L.

AU - Axelrod, David A.

N1 - Funding Information: The study was approved by the Dartmouth College Committee for the Protection of Human Subjects, the data oversight committee of the Organ Procurement and Transplantation Network (OPTN) and the Health Resources and Services Administration. This work was supported by a contract from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation (HHSH250201000018C). The work was also supported by an American Recovery and Reinvestment Act grant from the National Institute of Diabetes and Digestive and Kidney Diseases (RC1 1RC1DK086450-01). The data reported were supplied by the Minneapolis Medical Research Foundation, as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donors, waitlisted candidates and transplant recipients in the United States, submitted by the members of OPTN. Publisher Copyright: Copyright © 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

PY - 2016/2/1

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N2 - Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29 267; regional sharing, 29 005; eight districts, 29 034; four districts, 28 265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638 million to $1506 million, p < 0.001), transplant episode ($5607 million to $5569 million, p < 0.03) and posttransplant care ($479 million to $488 million, p < 0.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11 874 per patient, p < 0.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.

AB - Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29 267; regional sharing, 29 005; eight districts, 29 034; four districts, 28 265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638 million to $1506 million, p < 0.001), transplant episode ($5607 million to $5569 million, p < 0.03) and posttransplant care ($479 million to $488 million, p < 0.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11 874 per patient, p < 0.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.

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KW - business

KW - economics

KW - ethics and public policy

KW - health services and outcomes research

KW - hepatology

KW - liver disease

KW - liver transplantation

KW - management

KW - organ allocation

KW - organ procurement and allocation

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The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients

Abstract

Bibliographical note

Keywords

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