Using the Pharmacoepidemiology Approach to Evaluate the First-Year Posttransplantation Ambulatory Health Care Cost From the Longitudinal Health Insurance Database (2001 to 2006) in Taiwan

This research evaluated the total first-year posttransplantation ambulatory health care cost using a countrywide health claims database. We searched all health reimbursement claims of posttransplantation patients from 2001 to 2006 using the ICD-9-CM codes (V42.0, V42.1, V42.6, V42.7, V42.8) for kidney, heart, lung, liver, and other specified organ transplantations. We excluded patients undergoing transplantation surgery >12 months before 2001 or with <1 year of or irregular follow-up visits. All of the studied ambulatory care expenditures by visit files were based on the Taiwan Longitudinal Health Insurance Database (2005), which contained the claims of 1,000,000 beneficiaries who were randomly sampled from the Registry for Beneficiaries of the National Health Insurance Research Database. During this 6-year period we identified 336 transplant patients with 145 new cases having consecutive and >12 months of follow-up ambulatory visits to calculate the first-year posttransplantation cost. Among them, the first-year posttransplantation drug costs and total health care costs of the kidney, heart, lung, liver, and other organ transplantations were (m NTs) 346,396.6 ± 170,806.9 and 404,241.9 ± 182,499.1, 242,878.5 ± 128,772.7 and 302,325 ± 129,609.9, 345,792 ± 185,940.8 and 387,840.5 ± 184,244.5, 404,441.8 ± 299,311.7 and 471,631.5 ± 306,936.3 and 40,718.2 ± 50,740.2 and 67,469.8 ± 70,765.7, respectively. Drug expenditures were ∼80% of the total health care cost except for the other specified organ transplant, i.e., bone marrow, wherein they were 60%. The mean differences between drug expenditures and total costs of various organ transplants were significant (P < .01; ANOVA). Despite the first-year health care cost a the posttransplantation patient being less than dialysis costs in Taiwan, most end-stage renal disease patients are still a waiting organ donation; therefore, some candidates are seeking a transplants outside Taiwan.