Renal transplantation
Rehospitalization
Primary Kidney Disease and Post–Renal Transplantation Hospitalization Costs

https://doi.org/10.1016/j.transproceed.2007.03.007Get rights and content

Abstract

Background and aim

This study sought to assess posttransplantation hospitalizations costs in diabetic and nondiabetic subjects to see whether diabetes mellitus (DM) as a primary cause of end-stage renal disease (ESRD) increased posttransplantation hospitalization costs.

Methods

From 2000 to 2005, the hospitalization costs of 387 consecutive rehospitalizations of kidney recipients were retrospectively compared for two groups: patients with ESRD due to DM (n = 71) and those with ESRD of non-DM etiologies (n = 316). The hospitalization costs included the costs of hotel, medications, surgical procedures, paraclinical tests, imaging tests, health personnel time, special services (ie, patient transportation by ambulance), and miscellaneous costs. Societal perspective was used with costs expressed in PPP$ purchase power parity dollars (PPP$) estimated to be equal to 272 Iranian rials.

Results

Compared with the non-DM group, DM patients experienced significantly higher median costs both in total (1262 vs 870 PPP$, P = .001) and in cost components related to hotel (384 vs 215 PPP$, P = .001), health personnel time (235 vs 115 PPP$, P < .001), paraclinical tests (177 vs 149 PPP$, P = .012), and special services (100 vs 74 PPP$, P = .041). The mean of age was higher (P < .001), and the transplantation hospitalization time interval was also shorter in the DM group (median: 2.7 vs 12, P = .025).

Conclusions

Considering DM as a leading cause of ESRD and its increasing prevalence in some countries, the association between hospitalization costs of posttransplant patients and DM may be of great economic importance to many transplantation centers.

Section snippets

Methods

From 2000 to 2005, the hospitalization costs of 387 consecutive rehospitalizations of kidney recipients were retrospectively extracted from patient hospital records. Our renal transplantations date back to 1992, with a total number of 2269. Rehospitalization was defined as a hospital admission that occurred for any medical reason after discharge from the initial transplantation hospitalization. Rehospitalizations were divided into two groups: those happening in the patients with ESRD due to

Results

Of 387 rehospitalized cases (mean age ± SD: 39.4 ± 14.8 years), which included 316 men and 71 women of whom 71 (18.3%) and 316 (81.7%) fell into DM and non-DM groups, respectively. The mean age ± SD of in DM and non-DM groups was 51.5 ± 11.5 and 36.7 ± 14.1 years, respectively.

Table 1 shows the patient sex, ESRD etiology, source of kidney graft, hospitalization cause, frequency of intensive care unit admissions, and mortality in the two groups of patients. The mean of age in DM group was higher

Discussion

This study reported an association between higher posttransplantation inpatient direct medical costs and DM as the primary kidney disease. Each posttransplantation rehospitalization of DM patients cost society about 1.5-fold more than that of a non-DM patient.

The findings of this study may be valuable for transplantation centers. DM is the main cause of ESRD in several countries over the world.18 In particular, DM has been reported to be the leading cause for renal transplantation among ESRD

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  • Cited by (11)

    • Rehospitalization after kidney transplantation during the first year: Length, causes and relationship with long-term patient and graft survival

      2011, Transplantation Proceedings
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      Miscellaneous etiologies included posttransplant diabetes melitus, posttransplant hypertension, and anemia. Because rehospitalizations are possible for more than one cause, the sum of the frequencies of hospitalization causes is more than 100%.8,9 Graft function and mortality rate were also reviewed.

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    This study was fully supported and funded by Baqiyatallah Medical Sciences University.

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