Impact of the heart transplant allocation policy change on inpatient cost of index hospitalization.

Background: We sought to determine the financial impact of the United Network for Organ Sharing heart transplant (HT) allocation policy change of October 2018.

Methods: Using the Nationwide Inpatient Sample we retrospectively analyzed hospital discharge data between January 1, 2016 and December 31, 2019. ICD-10-CM procedure codes were used to identify hospitalizations of patients undergoing HT as well as the use of temporary mechanical circulatory support (MCS) during the HT hospitalization. Patients < 18 years old and those with missing data on costs were excluded. The primary outcome was inflation-adjusted costs. Total costs were inflated to 2019 US dollars.

Results: During the course of the study, temporary MCS increased significantly among 11 380 weighted patients transplanted while mean length of stay (LOS) did not. Mean inflation-adjusted costs rose about $40k per HT. On univariate analysis, transplantation year, use of temporary MCS and LOS were all significantly associated with increased cost while on multivariate analysis only temporary MCS and LOS were.

Conclusions: The 2018 allocation change has resulted in more expensive inpatient costs for HT correlating with an increase in temporary MCS.