Wednesday, December 7, 2022

Bernard Ross On Tackling the Financial Burden of Transplantation Surgery with Medical Technology (MedTech)

Bernard Ross, CEO of Sky Medical Technology

An expensive path to recovery

According to the Global Observatory on Donation and Transplantation (GODT), more than 150,000 organs were transplanted worldwide in 2019. Of the organs transplanted, more than 100,000 were kidneys.

In the US, almost 170 million living people (60 percent of adults) are registered as organ donors. However, only three in every 1,000 donors die in a way that allows their organs to be used. Many donors’ organs may be unsuitable for grafting due to the nature of their death or simply because organ health has deteriorated in old age.

Transplantation is the most effective treatment for end-stage organ failure, but a lack of donors means 17 people die on average every day in the US waiting for available organs for transplantation. Even those fortunate enough to receive an organ match are still faced with a substantial burden both physically and financially. Frequent care and monitoring are required before and immediately after surgery, throughout recovery, and for the months and years after, contributing to significant medical costs to the healthcare system.

Managing surgical costs

In 2020, the average kidney transplant in the US costs US$442,500. Around half of these costs came from hospital transplant admission – including the cost of a hospital bed, critical nursing care, and medication during the stay. Procurement costs – such as the retrieval, preservation, and transportation of the kidney – are also significant, averaging at US$113,900 per kidney transplant.

Although expensive, these costs are justifiable. Transplanting vital organs requires substantial amounts of time and resources, as well as knowledge and expertise. The number of hospital staff required for each surgery is high with transplant surgeons, physicians, coordinators, and dieticians all involved. The patient then spends significant time in a high dependency ICU with further substantial staffing requirements 24-7.

If the organ donor has died, expensive medication is needed to keep the organs healthy; if the donor lives far away, chartered flights are required to collect and transport the organs where they need to go.

A waiting game

There are also costs associated with managing a patient’s illness while they wait for a donor match. Billed charges in the 30 days leading up to the transplant surgery can reach $32,700, covering costs of blood and tissue typing and serum, cross-matching for donor compatibility, lab tests, and X-rays. Even once a match is identified, patients must then also wait for the graft and subsequent delivery of the organ. In 2017, the average waiting time to receive a kidney transplant was 685 days compared to 213 for a heart.4 That is almost two years of managing end-stage kidney disease – a condition that, as with any organ disease, has a significant impact on quality of life.

Managing end-stage kidney disease involves taking various medicines and undergoing kidney dialysis to keep the patient as healthy as possible. Typically, a hemodialysis schedule consists of three sessions per week, for up to five hours per session at a medical facility. This treatment is restrictive, inconvenient, time-consuming, and does not offer long-term solutions; only 35 percent of patients live after five years of hemodialysis treatment. Hemodialysis is both physically exhausting for patients and expensive – one year of hemodialysis can cost approximately US $72,000. Patients waiting for a kidney donor match need to carefully manage their condition, however, a lack of suitable donors means that 12 people die every day while waiting for a kidney transplant.

A long road to recovery

Even once a patient has undergone transplantation surgery, the costs continue long after they are discharged from the hospital. With every transplant surgery, there is a risk that a patient’s body will reject the new organ or develop other complications later in their life. To prevent rejection, transplant patients take immunosuppressive drugs for the rest of their lives. However, such drugs can have subsequent negative impacts on the patient’s overall health, making it harder to fight off infections, potentially boosting the risk of other diseases, such as diabetes and cancer.

Approximately US$85,500 is spent during the 180-day period following kidney transplantation surgery, including post-discharge facility, hospital readmissions, regular lab tests, and the evaluation and treatment of complications.4

In most circumstances, transplantation costs cannot be reduced without the success of the transplant being negatively impacted. It is not possible to, for instance, reduce the cost of the testing and treatment required up to transplantation surgery without risking the condition deteriorating quickly. However, speeding up recovery, and making successful recovery more likely, can help to significantly reduce post-surgical costs.

A strategy for enhanced recovery

By reducing the amount of time spent in hospital post-surgery, and by addressing the primary reasons why complications take place in recovery, healthcare professionals can create a virtuous circle – reducing the amount of time a patient spends in recovery and saving costs.

The average hospital stay for patients undergoing heart transplantation surgery in the US is more than 49 days, while kidney transplant patients experience much shorter stays between six and seven days.4 Reducing time spent in hospital post-operation is one of the most effective ways to dramatically reduce hospital transplant costs.

If healthcare systems can introduce innovative solutions to enhance recovery from transplantation surgery, reduce hospital stays and decrease the costs of the 180 days post-transplant discharge, healthcare systems can save thousands of dollars per transplant.

Reducing costs can primarily be achieved through reducing hospital readmissions – a common occurrence following organ transplantation surgery. Around one-third of all kidney transplant patients are readmitted to the hospital within 30 days of discharge. If patients have the power to better manage their recovery at home following discharge, readmissions can be cut.

Making recovery more effective with MedTech

Healthcare professionals are beginning to adopt innovative technological solutions to transform post-surgical recovery, helping to improve patient outcomes and make transplantation surgery more cost-effective. The concept is simple: if patients spend less time in hospital recovering, move their recovery into the home setting sooner, and reduce complications following surgery, the procedure will cost healthcare systems less money. This would also allow hospitals to care for more patients and free up more hospital beds.

Existing MedTech is already making breakthroughs in post-surgical recovery. A random controlled trial conducted by Lawson Health Research Institute (LHSC), in Ontario, Canada, found that a wearable MedTech device helped to shorten kidney transplantation hospital stays by more than one day and reduce surgical site infections by nearly 60 percent. As transplant patients are at increased risk of infections, devices that can reduce infection rates will benefit the patient as well as reduce the financial burden. Surgical wound infections are one of the most expensive types of healthcare-acquired infections, costing more than US$ 20,000 per patient. Devices that can reduce infections while discharging patients earlier have the potential to save thousands of dollars per transplantation surgery.

Improving long-term outcomes while reducing costs

The next steps in reducing surgical costs need to come from innovations that enhance recovery. Surgery is already reaching the frontiers of what is possible – new techniques such as laser surgery and robotic surgery have made procedures more accurate and less invasive. But the gains offered by innovation in surgery are increasingly marginal. This is why healthcare professionals are now looking at recovery as a place to innovate, finding new ways to reduce infection rates, decrease the length of a hospital stay and – crucially – increase the quality of life following surgery. The challenge is finding solutions that are more cost-effective than those that already exist.

MedTech that can reduce the rate of infections and time spent in in-patient care has the potential to contribute to a significant reduction in healthcare costs. However, for innovation to thrive, greater investment is required in medical device manufacturers to allow for the necessary clinical trials, design developments and regulatory approval to be achieved – all of which take years to complete. With the right investments and enough clinical data, innovation has the potential to transform patient recovery and reduce costs, helping relieve the financial burden of surgery for healthcare systems across the globe.


References:

[1] Organ Donation and Transplantation Activities. Global Observatory on Donation and Transplantation (GODT). 2019. Accessed March 2022. http://www.transplant-observatory.org/wp-content/uploads/2021/06/GODT2019-data_web_updated-June-2021.pdf

[1] Organ Donation Statistics. HRSA Organ Donor. [Website]. Accessed March 2022. https://www.organdonor.gov/learn/organ-donation-statistics#:~:text=As%20of%202021%2C%20169%20million,allows%20for%20deceased%20organ%20donation.

[1] Facts and Myths About Organ Donation. American Transplant Foundation. 2022. [Website]. Accessed March 2022. https://www.americantransplantfoundation.org/about-transplant/facts-and-myths/

[1] Bentley, T, S., Ortner, N, J. 2020 U.S. organ and tissue transplants: Cost estimates, discussion, and emerging issues. Milliman Research Report. [Website]. Accessed March 2022. www.milliman.com/-/media/milliman/pdfs/articles/2020-us-organ-tissue-transplants.ashx

[1] The Kidney Project. University of California San Francisco. 2018. [Website]. Accessed March 2022. https://pharm.ucsf.edu/kidney/need/statistics

[1] United States Renal Data System. 2021 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2021.  https://adr.usrds.org/2021

[1] Kidney Disease: The Basics. National Kidney Foundation. [Website]. Accessed March 2022. https://www.kidney.org/news/newsroom/fsindex

[1] Organ Transplants Without Life-Long Drugs. National Institutes of Health. 2012. [Website]. Access March 2022. https://www.nih.gov/news-events/nih-research-matters/organ-transplants-without-life-long-drugs.

[1] McAdams-Demarco MA, Grams ME, Hall EC, Coresh J, Segev DL. Early hospital readmission after kidney transplantation: patient and center-level associations. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2012;12(12):3283–3288. [PubMed] [Google Scholar]

[1] Simple device improves care after kidney transplantation. EurekAltert. Lawson Health Research Institute. [Website]. Accessed March 2022. https://www.eurekalert.org/news-releases/561606

[1] Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039–46.

View Mr. Ross article on The Burden of Venous Leg Ulcers and Limited Health Literacy, published January 28, 2022 here.

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