Lisa M. Willoughby, Sumina Fukami, Suphamai Bunnapradist, Jeffrey A. Gavard, Krista L. Lentine, Karen L. Hardinger, Thomas E. Burroughs, Steven K. Takemoto, Mark A. Schnitzler (2007) Health insurance considerations for adolescent transplant recipients as they transition to adulthood Pediatric Transplantation 11 (2), 127–131.

What Happens When The Money Runs Out?

Advances in medical and surgical techniques often prolong life and decrease mortality but also create new problems.

In this case, improved immunosuppression and allograft outcomes have resulted in more than 90 percent of pediatric and adolescent patients not only surviving but doing well one year post-operation. That means there is also a growing number of patients taking expensive immunosuppressive medications for the rest of their lives.

While the costs of most transplantation procedures in the USA currently are covered by Medicare, these benefits end 36–44 months after transplantation or when the patient reaches adulthood. Immunosuppressive drugs can cost in excess of $13,000 a year, representing a significant financial burden for even those families with private health insurance because of co-payments . The patients themselves, especially young adults, can rarely afford to pay for these drugs, especially since only about 30 percent of young adults have health insurance.

The consequence of this economic predicament is that preventable rejections of many transplanted organs take place and patients’ lives are shortened. In one reviewed study, the rate of graft loss doubled with the termination of Medicare coverage. And, once the transplanted kidney no longer works, the risk of death increases by a factor of 9. Further, the healthcare costs of failed transplants are 10 times higher than functioning transplants.¹

Commentary

The message is simple and stark: Chronic diseases require chronic care and entail chronic costs.

Individuals, families, and society must make difficult decisions about the long-term consequences of interventions such as transplantation - specifically, how costs and compliance can be managed.

Footnotes

1. G. Machnicki, L. Seriai, M. Schnitzler, Economics of transplantation: a review of the literature. Transplantation Reviews, April 2006. Volume 20, Issue 2, Pages 61-75 [back]

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