A pharmacoeconomic analysis of liver transplant charges

Objective - To analyze hospital charges for all liver transplant admissions to determine major cost drivers of the total charge. Study Design - Retrospective review of hospital billing records. Methods - Hospital charges were collected for all liver transplant admissions between July 1995 and December 2005 and 276 billing records were included in the analysis. Charges were itemized into pharmacy, inpatient room, laboratory, organ acquisition, and other. Results - Despite maintaining a median length of stay of about 10 days, hospital charges increased from 1995 to 2005. Mean total pharmacy charges (± SEM) before a 1998 cost-containment initiative were $17 405 ±$4080 and constituted a 12% fraction of total charges, but had reduced to $11 238 ±$2828 (7.8% of total charges) immediately thereafter, decreasing to $9891 ±$2351 (3.7% of total charges) for the most current period (2005). The increase in the total charge was largely driven by an increase in the organ acquisition charge and daily laboratory and room charges. Conclusions - Pharmacy charges no longer are a major contributor to the total liver transplant charges at our institution. A major reduction in total liver transplant charge can now only be achieved by targeting other cost centers such as laboratory, room, and organ acquisition. The transplant team has limited control over these cost centers.