Elsevier

Transplantation Proceedings

Volume 49, Issue 1, January–February 2017, Pages 4-9
Transplantation Proceedings

The Transplantation Science Symposium Asian Regional Meeting
General topics
Cost Analysis of Transplantation in Japan, Performed With the Use of the National Database

https://doi.org/10.1016/j.transproceed.2016.10.007Get rights and content

Abstract

Background

When assessing the cost of transplants in Japan, earlier studies have been limited to case series that investigated inpatient cost alone. Few studies have evaluated total cost, which includes inpatient, outpatient, and pharmaceutical costs, or compared costs before and after transplantation. Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), we investigated the total cost of major transplantation and contributing factors.

Methods

We analyzed the cost and complications of patients who underwent a cadaveric renal transplantation (CRT), living renal transplantation (LRT), living-donor liver transplantation (LDLT), allogeneic bone marrow transplantation, autologous bone marrow transplantation, allogeneic peripheral blood stem cell transplantation, or autologous peripheral blood stem cell transplantation (auto-PBSCT) from April 2009 to March 2010.

Results

The highest total cost of the month of transplantation was 4.95 million yen (JPY) for LDLT. Among renal transplantations, the cost of CRT was higher than LRT (3.69 vs 3.55 million JPY). Recipients of auto-PBSCT complicated by graft-versus-host disease, urinary tract infection, sepsis, or pneumonia had a significantly higher average total cost during the month of transplantation and the 2 following months than patients without it, as well as statistically longer total treatment days.

Conclusions

In Japan, almost all medical services are covered by national health insurance, and the Japan government has begun to allow the use of the NDB for research activities. This is the first study to use the NDB to analyze the cost of transplantation, with technical and institutional limitations.

Section snippets

Methods

To use inpatient, outpatient, and drug prescription claims data from the NDB, we established a secure analysis system in accordance with the guidelines [10] developed by the MHLW and applied to the Ministry for data provision. After assessment by the advisory committee, we obtained all claims data of recipients who had undergone a cadaveric renal transplantation (CRT), living renal transplantation (LRT), living-donor liver transplantation (LDLT), allogeneic bone marrow transplantation

Results

A total of 68 CRT, 98 LRT, 12 LDLT, 91 allo-BMT, 20 auto-BMT, 51 allo-PBSCT, and 1,471 auto-PBSCT patients were included in this study.

Table 1 presents the average total cost of the month of transplantation for each procedure. The highest total cost was 4.95 million yen (JPY) for LDLT. Among renal transplantations (RTs), the cost of CRT was greater than LRT (3.69 million JPY vs 3.55 million JPY). Among hematopoietic stem cell transplantations, allogeneic transplantation was more expensive than

Discussion

This is the 1st study analyzing the total cost of transplantation with the use of claims data obtained from the NDB. Our study investigated the total treatment cost before and after transplantation, as well as the relationship between cost, LOS, total treatment days, and complications for each type of transplant.

Nakatani et al [5] reported on the 1-year cost of 50 inpatients after RT on the basis of the billing prices of their own hospital. The average 1-year cost of LRT without ABO

Conclusion

By using the claims data extracted from the NDB, we investigated the total cost before and after transplantation, as well as the relationship between complications following transplantation and cost. Our results suggest that the onset of pneumonia after auto-PBSCT and allo-BMT leads to an increased total cost during a 3-month period that includes the month of transplantation and the 2 following months. Prevention of pneumonia after transplantation may reduce the economic burden on the

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There are more references available in the full text version of this article.

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