An economic analysis of pancreas transplantation: Costs, insurance coverage, and reimbursement

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Abstract
Since 1988 the demand for the pancreas transplantation has continued to increase. This has been accompanied by a growth in the number of centers offering the procedure, and an increase in the number of transplants performed. The National Cooperative Transplantation Study was undertaken to document the costs of all transplants, including pancreas transplantation. Data on transplantation procedure charges, from date of transplant to discharge, were obtained from 66.7% of all pancreas transplantation programs active in 1988. These programs accounted for 72% of all transplants performed that year. Valid sample survey data (no more than 25 transplants per center) were obtained for 133 randomly selected patients. This constituted 54% of all procedures done in the United States in 1988. Detailed data were also collected on sources of payment and amount reimbursed. Due to outlier data, we report statistical medians, rather than means, as our measure of central tendency. The median charge for a pancreas transplant with or without a kidney was $66 917, with a hospital length of stay of 21 days, compared with a kidney transplant alone at $39 625 and a hospital length of stay of 14 days. Total pancreas transplant charges fell between $45 260 and $105 375 for 50% of the cases studied. Half of the patients had a hospital length of stay between 16 and 33 days. Due to the small number of cases available for analysis, it was not meaningful to cross‐classify the data according to various prognostic variables. Fifty percent of the transplants studied were paid for by private insurers, and reimbursement exceeded 80% of billed charges for 50.6% of the cases analyzed. Insurance reimbursement for pancreas transplantation is not uniform, but is favorable for those covered. While the number of procedures performed annually has increased since 1980, with the largest increases occurring since 1988, sustained growth may well be a function of insurance coverage. Many transplant centers are unable to bear the expense of pancreas transplants insurers fail to cover. As a result, access will be a problem for some patients.

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