Investigating the Costs of Pediatric Intestine Transplants: Key Factors and Implications

UPMC Children’s Division of Pediatric Gastroenterology, Hepatology and Nutrition faculty led a new study recently published in the Journal of Parenteral and Enteral Nutrition examining the costs and key variables associated with pediatric intestine transplants. The research analyzed pediatric intestine transplant data in the Pediatric Health Information System database from cases conducted between 2004 to 2020 to better understand the economic implications of these transplants.

Leading the study was Vikram Raghu, MD, MS, assistant professor of Pediatrics in the Division of Pediatric Gastroenterology, Hepatology and Nutrition. Jeffrey A. Rudolph, MD, director of the UPMC Children’s Intestinal Care and Rehabilitation Center (ICARE); Simon P. Horslen, MBChB, director of Hepatology at UPMC Children’s; and George V. Mazariegos, MD, chief of Pediatric Transplantation at UPMC Children’s all contributed to the analysis.  Collaborators on the study outside UPMC Children’s included Scott D. Rothenberger, PhD, and Kenneth J. Smith MS, MS, from the University of Pittsburgh Department of Medicine.

Study Design and Main Findings

Dr. Raghu and colleagues examined data from 376 pediatric intestine transplant cases conduced at nine medical centers. Most of the transplant recipients suffered from short bowel syndrome (78%).

The median cost from transplant to discharge was found to be $263,724, with the median length of stay in the hospital being 51.5 days. These costs and durations varied depending on specific patient and treatment characteristics. For instance, transplants involving a liver were associated with an increased cost of $31,805. Additionally, the use of T-cell-depleting antibodies and the drug mycophenolate mofetil in immunosuppressive regimens significantly bumped up the costs, by $77,004 and $50,514 respectively.

Given these findings, the study underscores the considerable immediate costs and extended hospital stays linked with pediatric intestine transplants. It further indicates that these costs and durations can vary depending on the specifics of the medical center, the type of graft used, and the chosen immunosuppression regimen.

Future research from the team will explore the cost-effectiveness of various management strategies in the pre- and post-transplant phases, with a view to optimizing patient outcomes while efficiently managing resources.

Reference

Raghu VK, Rothenberger SD, Rudolph JA, Mazariegos GV, Horslen SP, Smith KJ. Pediatric Intestine Transplant Cost: Analysis of the Pediatric Health Information System Database. JPEN J Parenter Enteral Nutr. 2023 May; 47(4): 511-518.