Changes in pediatric heart transplant hospitalization costs over time

Background Despite significant changes in the past decade for children undergoing heart-transplantation, including the evolution of mechanical circulatory support and increasing patient complexity, costs and resource utilization have not been reassessed. We sought to utilize a novel linkage of clinical-registry and administrative data to examine changes in hospitalization costs over time in this population. Methods We identified all pediatric heart transplant recipients in a unique linked PHIS/SRTR dataset (2002-2016). Hospital costs were estimated from charges using cost-to-charge ratios, inflated to 2016 dollars. Severity-adjusted costs were calculated using generalized linear mixed-effects models. Costs were compared across 3 eras (Era-1:2002-2006; Era-2:2007-2011; and Era-3:2012-2016). Results A total of 2896 pediatric heart transplant recipients were included; Era-1:649 (22.4%), Era-2:1028 (35.5%), and Era-3:1219 (42.1%). ECMO support at transplant decreased over time, concurrent with an increase in VAD-supported patients. Between Era-1 and Era-2 there was an increase in pretransplant hospitalization costs ($343,692 vs. $435,554; p

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