The Economic Implications of Noninvasive Molecular Testing for Cardiac Allograft Rejection

doi:10.1111/j.1600-6143.2005.00869.x

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Wiley InterScience

American Journal of Transplantation

Volume 5 Issue 6, Pages 1553 - 1558

Published Online: 18 Apr 2005

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Brief Communication

The Economic Implications of Noninvasive Molecular Testing for Cardiac Allograft Rejection

Roger W. Evans ^a,*, Gavin E. Williams ^b , Helen M. Baron ^c , Mario C. Deng ^d , Howard J. Eisen ^e , Sharon A. Hunt ^f , Mahmud M. Khan ^g , Jon A. Kobashigawa ^h , Eric N. Marton ⁱ , Mandeep R. Mehra ^j and Seema R. Mital ^k

^a Rochester, MN, USA ^b XDx, Inc., South San Francisco, CA, USA ^c Division of Cardiology, Columbia University, New York, NY, USA ^d Department of Medicine, Columbia University, New York, NY, USA ^e Department of Medicine, Drexel University, Philadelphia, PA, USA ^f Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA ^g Department of Health Systems Management, Tulane University, New Orleans, LA, USA ^h Division of Cardiology, University of California at Los Angeles, Los Angeles, CA, USA ⁱ University Cardiovascular Medical Group, Inc., Los Angeles, CA, USA ^j Division of Cardiology, University of Maryland, Baltimore,MD, USA ^k Department of Pediatrics, Columbia University, New York, NY, USA

*Corresponding author: Roger W. Evans, Evans.Roger@Charter.net

KEYWORDS

Endomyocardial biopsy • cost • heart transplantation • gene expression profiling • reimbursement • economics

ABSTRACT

Endomyocardial biopsy is the mainstay for monitoring cardiac allograft rejection. A noninvasive strategy—peripheral blood gene expression profiling of circulating leukocytes—is an alternative with proven benefits, but unclear economic implications. Financial data were obtained from five cardiac transplant centers. An economic evaluation was conducted to compare the costs of outpatient biopsy with those of a noninvasive approach to monitoring cardiac allograft rejection. Hospital outpatient biopsy costs averaged $3297, excluding reimbursement for professional fees. Costs to Medicare and private payers averaged $3581 and $4140, respectively. A noninvasive monitoring test can reduce biopsy utilization. The savings to health care payers in the United States can be conservatively estimated at approximately $12.0 million annually. Molecular testing using gene expression profiling of peripheral circulating leukocytes is a new technology that offers physicians a noninvasive, less expensive alternative to endomyocardial biopsy for monitoring allograft rejection in cardiac transplant patients.

Received 16 November 2004, revised 19 January 2005 and accepted for publication 20 January 2005

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1600-6143.2005.00869.x About DOI