Kidney transplantation is a life-saving, but costly, treatment for patients with end-stage-renal-disease. Service use for patients who receive a kidney transplant has been relatively stable over the past decade. Recent changes in treatment regimens, however, particularly the introduction of the immunosuppressant medication cyclosporine, may have produced changes in overall service use and costs for these patients. There is little information available concerning factors associated with the use of services and costs for patients who receive transplants. The proposed project will shed light on these factors, specifically, the association with service use and costs of donor status, medication regimen, and clinical characteristics for patients who receive a renal transplant at the University of California, San Francisco (USCF), during the period, 1982 to 1986. This study will also access whether the longer graft survival achieved in recent years for cadaveric transplants has resulted in lower one-year costs for this group compared to living-related transplants, and, finally, the burden on the patient of the costs of immunosuppreossant medication will be evaluated. Data will be gathered from a variety of sources, including UCSF inpatient and outpatient medical and billing records, a brief questionnaire mailed to the patient, Medicare Part B physician billing records, and medical and billing records from other hospitals. By gathering information on inhospital, and one-year post-hospital, service use and costs, this study will be able to use multivariate data analytic techniques to analyze the independent associations with service use and costs of a variety of factors. The reults of this study should be useful to clinicians in their evaluations of the costs and effectiveness of different treatment regimens for kidney trnsplantations, as well as to policymakers in their analyses of ways to encourage the efficient use of resources to treat patients with end-stage-renal-disease.
