Differences in Pediatric Heart Transplant Outcomes by Payor Type Before and After the 2016 Allocation Changes

Thursday, September 21, 2023

1:00 PM – 1:10 PM CT

Location: Denver - Houston - Kansas City, 5th Floor

Member Speaker(s)

Andrew D. Vogel, MS

Medical Student
Alabama College of Osteopathic Medicine
Alabama College of Osteopathic Medicine

Disclosure(s): No financial relationships to disclose

Slides

Disclosure(s):

Andrew D. Vogel, M.S.: No financial relationships to disclose

Learning Objectives:

To describe the impact of the 2016 UNOS allocation changes on pediatric heart transplant patients with regard to their insurance type.
To understand the disparities in pediatric heart transplant allocation and payor status.
To define major outcomes that affect pediatric heart transplant patients.

Introduction/Purpose: Following significant changes to the pediatric heart transplant allocation system in 2016, the impact of insurance type on heart transplant outcomes remains unknown. We assessed the impact of these changes using a national cohort.

Methods or Case Description: The United Network for Organ Sharing database was queried to identify 5832 pediatric ( < 18 years) heart transplant recipients (6/11/2009 to 12/31/2022). Two eras of equal duration were analyzed: Era 1 was pre-allocation change (6/11/2009-03/21/2016, n=2752) and Era 2 was post-allocation change (03/22/2016-12/31/2022, n=3080). Within each era, patients were stratified by payor status (private vs. non-private).

Outcomes: In both eras, patients with private insurance were older than those with non-private insurance (7.5+6.6 years vs. 6.3+6.2 years in Era 1; 7.1+6.3 years vs. 6.3+6.2 years in Era 2; p < .001). Among status 1A patients, those with non-private insurance had longer waitlist time than those with private insurance in Era 2 (72.8+83.2 days vs. 54.8+53.9 days; p < .001), but this difference was not observed in Era 1 (68.1+81.3 days vs. 68.2+93.1 days, p=.956). Non-private insurance was associated with inferior 5-year survival in both Era 1 (82.6% vs. 85.8%, p< 0.001) and Era 2 (78.7% vs. 87.2%, p < .001).

Conclusion: In Era 2 but not Era 1, patients with non-private insurance face longer wait times in status 1a; both eras have decreased post-transplant survival when compared to patients with private insurance. Efforts to identify the causes of these differences and how to equalize waitlist times and outcomes for all payor types should be made by national level organizations as well as individual hospitals.