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{userid:"lentine.k", "articletype":"article","pages":"425-502","author":"M A Schnitzler, M A Skeans, D A Axelrod, K L Lentine, H B Randall, J J Snyder, A K Israni, B L Kasiske","year":"2017","title":"OPTN\/SRTR 2015 Annual Data Report: Economics.","month":"Jan","journal":"American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons","publisher":"","volume":"17 Suppl 1","number":"","note":"","tags":"","booktitle":"","editor":"","abstract":"While the costs to Medicare of solid organ transplants are varied and considerable, the total Medicare expenditure of $4.4 billion for solid organ transplant recipients in 2014 remained less than 1% of all Medicare expenditures. For patients covered by Medicare, the ratio of pre- to posttransplant cost of care varied widely by organ and within some organ categories by patient characteristics. This chapter reports pretransplant costs for all solid organ candidates covered by Medicare to allow investigators to further explore the relative cost of transplant compared with alternative management.","address":"","school":"","issn":"1600-6143","doi":"10.1111\/ajt.14130","isi":"","pubmed":"28052600","key":"Schnitzler2017","howpublished":"","urllink":"","refid":172,"weight":172}
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{userid:"abhijit.naik", "refid":"11","repocollections":"","attachment":"","_thumb":"","articletype":"article","sectionheading":"","title":"Variation in Comedication Use According to Kidney Transplant Immunosuppressive Regimens: Application of Integrated Registry and Pharmacy Claims Data.","year":"2016","author":"K L Lentine, A S Naik, M Schnitzler, D Axelrod, J Chen, D C Brennan, D L Segev, B L Kasiske, H Randall, V R Dharnidharka","journal":"Transplantation proceedings","volume":"48","number":"1","pages":"55-58","month":"Jan\/Feb","doi":"10.1016\/j.transproceed.2015.12.024","pubmed":"26915843","pdflink":"","urllink":"","abstract":"Modern immunosuppression therapies (ISx) have many side effects, and transplant recipients must take an array of \"comedications\" to help mitigate complications. Comedication use patterns are not well described in large, representative samples because of lack of data.","note":"","tags":"","weight":11,"publisher":"","booktitle":"","editor":"","address":"","school":"","issn":"1873-2623","isi":"","key":"Lentine2016","howpublished":""}
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{userid:"lentine.k", "articletype":"article","pages":"55-58","author":"K L Lentine, A S Naik, M Schnitzler, D Axelrod, J Chen, D C Brennan, D L Segev, B L Kasiske, H Randall, V R Dharnidharka","year":"2016","title":"Variation in Comedication Use According to Kidney Transplant Immunosuppressive Regimens: Application of Integrated Registry and Pharmacy Claims Data.","month":"Jan\/Feb","journal":"Transplantation proceedings","publisher":"","volume":"48","number":"1","note":"","tags":"","booktitle":"","editor":"","abstract":"Modern immunosuppression therapies (ISx) have many side effects, and transplant recipients must take an array of \"comedications\" to help mitigate complications. Comedication use patterns are not well described in large, representative samples because of lack of data.","address":"","school":"","issn":"1873-2623","doi":"10.1016\/j.transproceed.2015.12.024","isi":"","pubmed":"26915843","key":"Lentine2016","howpublished":"","urllink":"","refid":157,"weight":157}
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{userid:"suzanne.dahlberg", "articletype":"article","pages":"171-180","author":"Taofeek K Owonikoko, Joseph Aisner, Xin Victoria Wang, Suzanne E Dahlberg, Eric H Rubin, Suresh S Ramalingam, Murugesan Gounder, Paul Gregory Rausch, Rita S Axelrod, Joan H Schiller","year":"2014","title":"E5501: phase II study of topotecan sequenced with etoposide\/cisplatin, and irinotecan\/cisplatin sequenced with etoposide for extensive-stage small-cell lung cancer.","month":"Jan","journal":"Cancer chemotherapy and pharmacology","publisher":"","volume":"73","number":"1","note":"","tags":"Adult,Aged,Antineoplastic Combined Chemotherapy Protocols,Camptothecin,Cisplatin,Etoposide,Female,Humans,Lung Neoplasms,Male,Middle Aged,Neoplasm Staging,Small Cell Lung Carcinoma,Topoisomerase I Inhibitors,Topoisomerase II Inhibitors,Topotecan","booktitle":"","editor":"","abstract":"Sequence-dependent improved efficacy of topoisomerase I followed by topoisomerase 2 inhibitors was assessed in a randomized phase II study in extensive-stage small-cell lung cancer (SCLC).","address":"","school":"","issn":"1432-0843","doi":"10.1007\/s00280-013-2338-z","isi":"","pubmed":"24288121","key":"Owonikoko2014","howpublished":"","urllink":"","refid":21,"weight":21}
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{userid:"lentine.k", "articletype":"article","pages":"","author":"David A Axelrod, Issac R Schwantes, Alyssa H Harris, Samuel F Hohmann, Jon J Snyder, Ramji Balakrishnan, Krista L Lentine, Bertram L Kasiske, Mark A Schnitzler","year":"2022","title":"The need for integrated clinical and administrative data models for risk adjustment in assessment of the cost transplant care.","month":"Dec","journal":"Clinical transplantation","publisher":"","volume":"36","number":"12","note":"","tags":"Humans,Risk Adjustment,Registries,Comorbidity,Costs and Cost Analysis,Kidney Transplantation","booktitle":"","editor":"","abstract":"Value-based purchasing requires accurate techniques to appropriately measure both outcomes and cost with robust adjustment for differences in severity of illness. Traditional methods to adjust cost estimates have exclusively used administrative data derived from billing claims to identify comorbidity and complications. Transplantation uniquely has accurate national clinical registry data that can be used to supplement administrative data.","address":"","school":"","issn":"1399-0012","doi":"10.1111\/ctr.14817","isi":"","pubmed":"36065568","key":"Axelrod2022","howpublished":"","urllink":"","refid":219,"weight":219}
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{userid:"lentine.k", "articletype":"article","pages":"170-179","author":"D A Axelrod, N Dzebisashvili, K L Lentine, H Xiao, M Schnitzler, J E Tuttle-Newhall, D L Segev","year":"2015","title":"Variation in biliary complication rates following liver transplantation: implications for cost and outcome.","month":"Jan","journal":"American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons","publisher":"","volume":"15","number":"1","note":"","tags":"Adult,Aged,Brain Death,Cholangitis,Cohort Studies,Constriction, Pathologic,Cost-Benefit Analysis,Female,Follow-Up Studies,Graft Rejection,Graft Survival,Humans,Incidence,Liver Diseases,Liver Transplantation,Living Donors,Male,Middle Aged,Postoperative Complications,Prognosis,Risk Factors,United States,Young Adult","booktitle":"","editor":"","abstract":"Although biliary complications (BCs) have a significant impact on the outcome of liver transplantation (LT), variation in BC rates among transplant centers has not been previously analyzed. BC rate, LT outcome and spending were assessed using linked Scientific Registry of Transplant Recipients and Medicare claims (n = 16,286 LTs). Transplant centers were assigned to BC quartiles based upon risk-adjusted observed to expected (O:E) ratio of BC separately for donation after brain death (DBD) and donation after cardiac death (DCD) donors. The median incidence of BC was 300% greater in the highest versus lowest DBD quartiles (19.0% vs. 5.9%) and varied 250% between DCD quartiles (20.3%-8.4%). Donor and recipient characteristics suggest that high BC centers actually used lower donor risk index organs, fewer split livers and fewer imports (p < 0.001 for all). Transplant at a center in the highest O:E quartile was associated with increased posttransplant mortality (adjusted hazard ratio [aHR] 2.53, p = 0.007) in DCD transplant and increased graft loss (aHR 1.21, p = 0.02) in DBD transplant. Medicare spending was $22,895 (p < 0.0001) higher at centers in highest versus lowest BC quartile. In summary, BC rates vary widely among transplant centers and higher rates are a marker for an increased risk of death, graft failure and health-care spending.","address":"","school":"","issn":"1600-6143","doi":"10.1111\/ajt.12970","isi":"","pubmed":"25534447","key":"Axelrod2015","howpublished":"","urllink":"","refid":126,"weight":126}
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{userid:"lentine.k", "articletype":"article","pages":"169-194","author":"M A Schnitzler, M Valapour, M A Skeans, D A Axelrod, K L Lentine, H B Randall, J J Snyder, A K Israni, B L Kasiske","year":"2016","title":"Economics.","month":"Jan","journal":"American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons","publisher":"","volume":"16 Suppl 2","number":"","note":"","tags":"","booktitle":"","editor":"","abstract":"While the costs to Medicare of solid organ transplants are varied and considerable, the total Medicare expenditure of $4.2 billion for solid organ transplant recipients in 2013 remains less than 1% of all Medicare expenditures. Kidney transplant remains one of the most cost-effective surgical interventions in medicine and exhibits a rare feature in that it is generally known to be cost-saving in the long term. For patients covered by Medicare, lung transplant is one of the more costly solid organ transplants performed. This chapter reports pretransplant costs for lung candidates to allow investigators to further explore the relative cost of lung transplant compared with alternative management.","address":"","school":"","issn":"1600-6143","doi":"10.1111\/ajt.13672","isi":"","pubmed":"26755268","key":"Schnitzler2016","howpublished":"","urllink":"","refid":147,"weight":147}
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{userid:"abhijit.naik", "articletype":"article","pages":"","author":"V R Dharnidharka, A S Naik, D A Axelrod, M A Schnitzler, Z Zhang, S Bae, D L Segev, D C Brennan, T Alhamad, R Ouseph, N N Lam, M Nazzal, H Randall, B L Kasiske, M McAdams-Demarco, K L Lentine","year":"2017","title":"Center practice drives variation in choice of U.S. kidney transplant induction therapy: A retrospective analysis of contemporary practice.","month":"Oct","journal":"Transplant international : official journal of the European Society for Organ Transplantation","publisher":"","volume":"","number":"","note":"","tags":"","booktitle":"","editor":"","abstract":"To assess factors that influence the choice of induction regimen in contemporary kidney transplantation, we examined center-identified, national transplant registry data for 166,776 US recipients (2005-2014). Bi-level hierarchical models were constructed, wherein use of each regimen was compared pairwise with use of interleukin-2 receptor blocking antibodies (IL2rAb). Overall, 81.8% of patients received induction, including thymoglobulin (TMG, 46.0%), IL2rAb (21.9%), alemtuzumab (ALEM, 12.5%), and other agents (1.3%). However, proportions of patients receiving induction varied widely across centers (0%-100%). Recipients of living donor transplants and self-pay patients were less likely to receive induction treatment. Clinical factors associated with use of TMG or ALEM (vs. IL2rAb) included age, black race, sensitization, retransplant status, non-standard deceased donor, and delayed graft function. However, these characteristics explained only 10%-33% of observed variation. Based on intraclass correlation analysis, \"center effect\" explained most of the variation in TMG (58%), ALEM (66%), other (51%), and no induction (58%) use. Median odds ratios generated from case-factor adjusted models (7.66-11.19) also supported large differences in the likelihood of induction choices between centers. The wide variation in induction therapy choice across US transplant centers is not explained by differences in patient or donor characteristics; rather, it reflects center choice and practice. This article is protected by copyright. All rights reserved.","address":"","school":"","issn":"1432-2277","doi":"10.1111\/tri.13079","isi":"","pubmed":"28987015","key":"Dharnidharka2017","howpublished":"","urllink":"","refid":17,"weight":17}
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{userid:"lentine.k", "articletype":"article","pages":"2052-2058","author":"S E Gentry, A B Massie, S W Cheek, K L Lentine, E H Chow, C E Wickliffe, N Dzebashvili, P R Salvalaggio, M A Schnitzler, D A Axelrod, D L Segev","year":"2013","title":"Addressing geographic disparities in liver transplantation through redistricting.","month":"Aug","journal":"American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons","publisher":"","volume":"13","number":"8","note":"","tags":"End Stage Liver Disease,Geography,Health Services Needs and Demand,Healthcare Disparities,Humans,Liver Transplantation,Tissue Donors,Tissue and Organ Procurement,Waiting Lists","booktitle":"","editor":"","abstract":"Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90-day transplant rates range from 18% to 86% and death rates range from 14% to 82% across donation service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimized maps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28\u2009063 liver transplant candidates, and 242\u2009727 Model of End-Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p = 0.021), although it would decrease waitlist deaths (from 1368 to 1329, p = 0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p = 0.002) while achieving a larger decrease in waitlist deaths (to 1307, p = 0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States.","address":"","school":"","issn":"1600-6143","doi":"10.1111\/ajt.12301","isi":"","pubmed":"23837931","key":"Gentry2013","howpublished":"","urllink":"","refid":101,"weight":101}
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{userid:"lentine.k", "articletype":"article","pages":"583-593","author":"S E Gentry, E K H Chow, N Dzebisashvili, M A Schnitzler, K L Lentine, C E Wickliffe, E Shteyn, J Pyke, A Israni, B Kasiske, D L Segev, D A Axelrod","year":"2016","title":"The Impact of Redistricting Proposals on Health Care Expenditures for Liver Transplant Candidates and Recipients.","month":"Feb","journal":"American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons","publisher":"","volume":"16","number":"2","note":"","tags":"","booktitle":"","editor":"","abstract":"Redistricting, which means sharing organs in novel districts developed through mathematical optimization, has been proposed to reduce pervasive geographic disparities in access to liver transplantation. The economic impact of redistricting was evaluated with two distinct data sources, Medicare claims and the University HealthSystem Consortium (UHC). We estimated total Medicare payments under (i) the current allocation system (Share 35), (ii) full regional sharing, (iii) an eight-district plan, and (iv) a four-district plan for a simulated population of patients listed for liver transplant over 5 years, using the liver simulated allocation model. The model predicted 5-year transplant volumes (Share 35, 29,267; regional sharing, 29,005; eight districts, 29,034; four districts, 28,265) and a reduction in overall mortality, including listed and posttransplant patients, of up to 676 lives. Compared with current allocation, the eight-district plan was estimated to reduce payments for pretransplant care ($1638\u2009million to $1506\u2009million, p\u2009<\u20090.001), transplant episode ($5607\u2009million to $5569\u2009million, p\u2009<\u20090.03) and posttransplant care ($479\u2009million to $488\u2009million, p\u2009<\u20090.001). The eight-district plan was estimated to increase per-patient transportation costs for organs ($8988 to $11,874 per patient, p\u2009<\u20090.001) and UHC estimated hospital costs ($4699 per case). In summary, redistricting appears to be potentially cost saving for the health care system but will increase the cost of performing liver transplants for some transplant centers.","address":"","school":"","issn":"1600-6143","doi":"10.1111\/ajt.13569","isi":"","pubmed":"26779694","key":"Gentry2016","howpublished":"","urllink":"","refid":146,"weight":146}
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