OPTN Committee Data Request: Financial Analyses of Authors: Mark - - PowerPoint PPT Presentation

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OPTN Committee Data Request: Financial Analyses of Proximity Points Scenarios

Authors: Mark Schnitzler, PhD1 Sommer Gentry, PhD2 Presenter: Joshua Pyke, PhD3

• 1. Saint Louis University; SRTR Senior Staff
• 2. United States Naval Academy; SRTR Senior Staff
• 3. Scientific Registry of Transplant Recipients

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Committee Request

• Committee requested that SRTR prepare analysis of the

financial impact of each of the 28 models previously described.

• Analysis should incorporate transplant center expenditures.
• Analysis should include assessment of:
• Costs related to the transplant episode
• One year post-transplant costs
• Transportation costs

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Cost Overview

• Approach: combine cost-of-care models with simulated

transplants to estimate system costs for 28 scenarios

• Four cost models
• Pretransplant cost (Medicare data)
• Transplant episode + 1 year follow up cost (UHC data)
• Posttransplant cost (Medicare data)
• Transport cost (transport model)
• Focused on underlying system costs, not charges or

accounting

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Cost Data: Medicare

• Combined payments for all services from Medicare Parts A and B (inpatient, outpatient,

home health, and hospice)

• Payments for all services were summed and aggregated based on # of months each

candidate spent on the waiting list and number of years (first 3 years only) posttransplant

• Pretransplant costs included daily estimates of spending adjusted for lab MELD/PELD

score and other patient characteristics for the duration of listing

• Posttransplant cost per patient was estimated for 2 time periods:
• Early: 3 days before transplant to 1 year
• Late: year 1 to year 3 posttransplant
• Posttransplant costs censored at time of retransplant to capture cost associated with

first transplant

• Medicare payments were minimally adjusted for wage/price differences by region,

conforming with standard diagnosis related groups and the evaluation/management code-based fee schedule

• Did not include organ acquisition cost under Medicare claims, since these are paid via

institutional cost report

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Cost Data: UHC

• Dataset created by merging University HealthSystem

Consortium (UHC) hospital cost accounting data with OPTN data for liver transplants performed between 2002 and 2013.

• Transplant records were linked using date of transplant, age,

and gender (no unique identifiers available for this dataset).

• UHC data include patient-level cost data from administrative

billing claims submissions, adjusted to costs using the transplant hospital’s Medicare cost-to-charge ratio and adjusted for geographic differential in wages.

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Analytic Approach

• Multivariate linear regression was used to estimate monthly

(pretransplant) and total person-level (transplant episode and posttransplant) spending.

• Models were adjusted for recipient and donor factors relevant to

waitlist and transplant analysis.

• Recipient adjustment factors: Age, race, gender, blood group,

diagnosis category, HCC exception status, diabetes, cerebrovascular disease, working for income, daily biologic MELD or biologic MELD at transplant

• Donor adjustment factors: Age, race, gender, blood group, cause
• f death, donation after circulatory death
• Costs were adjusted for inflation based on consumer price index

inflation reported by the Bureau of Labor Statistics.

Proximity Points Results: Cost Metrics

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Overall cost (patient care and transport)

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Pretransplant cost per patient-month

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Pretransplant cost per year

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Transplant cost per patient

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Transplant cost per year

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E xpected Cost per Transplant and 1 Y ear Follow Up by ME LD/ PE LD

(The cost model is multivariate; this is the MELD/PELD portion assuming average values for other candidate and donor characteristics.)

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Distribution of Lab ME LD/ PE LD at Transplant

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Transplant Cost and UHC Data Summary

• UHC data allows for better modeling of the relationship between cost and lab

MELD/PELD at transplant

• Transplant costs per patient increased slightly among 4-district in-district

scenarios, remained largely stable across scenarios

• Transplant center costs increase as lab MELD/PELD increases. However,

modeled scenarios show little variation in distribution of lab MELD/PELD at transplant.

• For average patient with MELD 20-25, model predicts center cost increase
• f about $10,000 per MELD/PELD point
• Largest projected increase in national median MELD/PELD at transplant: 4

points (21→25) for 4 districts w/o proximity

• For 8 districts w/ proximity, projected national median MELD/PELD at

transplant: 2 points higher (21→23)

• Less than 25% of transplants fall in the MELD/PELD 20-25 range where

cost increases are steepest, so overall center transplant cost impact is only in the $10,000-$15,000 range

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Posttransplant cost per patient-month

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Posttransplant cost per year

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Overall cost (patient care)

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Transport cost per transplant

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Transport cost per year

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Overall cost (patient care and transport)

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Proximity Points Financial Analysis Summary

• Analysis modeled underlying system costs, not charges.
• Overall projected differences in cost for transport and patient care among the

28 scenarios were small, with only about a 2% difference between the most and least expensive scenarios.

• Pretransplant costs per year were somewhat lower for broader sharing

scenarios due to fewer patient-months at high lab MELD/PELD.

• UHC data allowed for modeling variability in transplant costs, which were

somewhat higher per year for broader sharing scenarios due to increased MELD/PELD at transplant.

• Posttransplant costs per year showed almost no variation between scenarios.
• While transport costs varied with higher costs estimated in scenarios that

involve more flying, they were a small proportion of total transplant costs, at about 3% of the total estimated cost of transplant care.

• Decreased pretransplant costs balanced increased transplant and transport

costs in most scenarios. Most redistricting options are projected to be cost- neutral or cost-saving.

Q & A

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Supplemental Slides: Proximity Points Financial Analysis

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Cost Data: Medicare

• Data Linkage:
• Linked clinical and demographic information from OPTN

data with Medicare billing claims for liver transplant candidates and recipients between 2002 and 2008

• Medicare billing claims provided payment information for

patients with Medicare fee-for-service primary or secondary insurance

• Beneficiary ID from Medicare files were linked to OPTN

records using Social Security number, gender, and date of birth

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Analytic Approach: Transportation Costs

• For each transplant, transport mode was predicted using a transport model that assigns

cost and mode of transportation based on estimated travel times (Gentry, Liver Transplantation, 20;1237-1243, 2014)

• Mode was:
• By ground if driving time was less than 2 hours (or 1.5 hours in OPOs that use

helicopters);

• By helicopter in OPOs that use helicopters where driving would take 1.5 hours or

more and the distance was 100 miles or less;

• By air from the nearest airport for longer distances
• Round-trip cost was estimated to be $1108 per team by ground transportation, $4742

per team by helicopter, and distance-dependent for flights. (Flight cost estimates based

• n transports for liver transplant in the Living Legacy Foundation OPO in 2013. Lynch,

American Journal of Transplantation, 9:10;2416-2423, 2009)

• Round-trip costs for flights were estimated by distance, using a formula of

$7,767+($8.40 x round trip miles). This cost includes the cost for aircraft charter, fuel, aircraft crew, and airport fees.

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Analytic Approach: Pretransplant Cost in LSAM

• Over each 5-year simulation, candidates began accruing

pretransplant (pre-tx) care costs from the beginning of simulation

• r date listed. The pre-tx period ended when the candidate

underwent transplant or was removed from the list.

• Cost of pre-tx care was estimated based on the number of days the

candidate was on the list with a lab MELD/PELD score of 6-40.

• We calculated average pre-tx care cost per patient month by:
• Summing total cost of pre-tx care was over each 5-year

simulation

• Calculating patient pre-tx costs per month by dividing total pre-

tx cost by cumulative months waiting.

• Averaging over number of candidates to find the reported

pretransplant cost per patient month

• Medicare cost data was used to estimate pretransplant cost

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Analytic Approach: Transplant and 1-Y ear Follow- Up Cost in LSAM

• Within each 5-year simulation, candidates who underwent

transplant accrued the total cost of transplant procedure plus 1 year of follow-up care.

• Transplant and 1 year cost per patient was calculated by

dividing the total transplant and 1 year cost over the 5-year simulation by the number of patients who underwent transplant.

• UHC cost data was used to estimate transplant and 1-year

follow up cost.

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Analytic Approach: Posttransplant Cost in LSAM

• Transplant recipients within the simulation began accruing late

posttransplant (post-tx) care expenditures from 1 year post-tx until date of death, relisting, or end of each 5-year simulation.

• We assumed that the annual cost of care beyond 3 years was

equivalent to the annual cost of care in years 2 and 3 post-tx.

• We calculated average post-tx cost per patient month by:
• Summing total post-tx cost was summed over each 5-year

simulation

• Dividing the cost of care after 1 year post-tx by the number of

months survived after 1 year post-tx

• Averaged this over the number of transplant recipients who

survive to 1 year post-tx to get the reported average post-tx cost per patient-month

• Medicare cost data was used to estimate posttransplant cost.

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Summary Cost Analysis Table

Pretransplant cost per year ($MM) Transplant cost per year ($MM) Posttransplant cost per year ($MM) Transport cost per year ($MM) Overall cost per year ($MM) current 402.4 (392.1-415.7) 1279.5 (1263.4-1291.8) 57.9 (56.9-58.6) 50.9 (50-51.6) 1790.6 (1771.9-1799.8) 11 Regions 381.1 (371.5-395.2) 1265.5 (1249.5-1275.9) 56.9 (56.1-57.7) 62.9 (62.1-63.8) 1766.4 (1751.8-1779.7) 4 Districts 363.2 (356.8-378.3) 1293 (1276.7-1304.2) 57.4 (56.2-58.2) 85.8 (84.8-86.7) 1799.3 (1785.6-1814.7) 8 Districts 362.1 (353.2-377.2) 1278.5 (1264.8-1290.6) 57.1 (56.2-58) 71 (70.2-71.4) 1768.8 (1750.5-1783.8) 11R 3P 150Mi In 380.4 (366.7-394.3) 1273.8 (1256.7-1286.5) 57.4 (55.8-58.4) 58.1 (57.5-59) 1769.7 (1750.6-1779.6) 11R 3P 150Mi Out 377.6 (369.4-389.1) 1298.1 (1285.6-1311.1) 58 (56.9-59.2) 57.2 (56.8-57.7) 1790.9 (1772-1802.8) 11R 3P 250Mi In 381.2 (370.5-392.7) 1268.9 (1253.4-1281.3) 57.1 (56.1-58.1) 59.3 (58.5-60.1) 1766.5 (1751.7-1774) 11R 3P 250Mi Out 368.3 (360.8-378.8) 1279.3 (1262.5-1292.3) 57 (55.9-57.5) 58.3 (57.5-58.8) 1762.9 (1746.1-1773.5) 11R 5P 150Mi In 382.6 (369.5-398.2) 1274 (1255.1-1286.7) 57.4 (56-58.1) 55.2 (54.7-55.9) 1769.3 (1749.6-1780.4) 11R 5P 150Mi Out 378.2 (371.7-390.8) 1298.1 (1280.6-1310.9) 57.8 (56.5-58.6) 57.1 (56.1-57.7) 1791.3 (1779.1-1798.3) 11R 5P 250Mi In 382.2 (366.6-397) 1269.8 (1253.5-1283) 57.4 (56.2-57.9) 57.4 (56.5-57.9) 1766.7 (1742.4-1777.5) 11R 5P 250Mi Out 368.2 (355.4-379.5) 1279.5 (1262.6-1292.6) 56.9 (55.8-57.8) 58.2 (57.2-58.7) 1762.8 (1744.3-1773.8) 4D 3P 150Mi In 355.5 (345.5-369) 1302.3 (1285.3-1313.6) 57.9 (57-58.9) 75.3 (74.5-75.8) 1790.9 (1774.3-1802.5) 4D 3P 150Mi Out 378.1 (371.8-391.5) 1297.9 (1284.2-1312.5) 58.4 (57.2-59.7) 57 (55.9-57.9) 1791.5 (1780.1-1801.5) 4D 3P 250Mi In 357.9 (350.2-369.6) 1299 (1286-1310.4) 57.8 (56.2-58.7) 75.4 (74.3-76.1) 1790.1 (1770.4-1803.8) 4D 3P 250Mi Out 367.1 (354.8-377.8) 1278.6 (1263.5-1291.9) 57.3 (56-58.2) 58.3 (57.7-59.1) 1761.3 (1741.2-1772.3) 4D 5P 150Mi In 359.1 (347.4-371.2) 1303.9 (1289.2-1318.5) 58.1 (56.9-59.1) 70 (69.4-70.7) 1791.1 (1772.1-1803.9) 4D 5P 150Mi Out 377.1 (369-390.3) 1298.3 (1281.6-1312.8) 58.3 (57.2-58.9) 57.2 (56.5-57.9) 1790.9 (1775.6-1798.5) 4D 5P 250Mi In 361.1 (350-375.8) 1298.9 (1283.5-1310.9) 57.7 (56.4-58.1) 71.2 (70.4-71.6) 1788.9 (1770.6-1802.3) 4D 5P 250Mi Out 367.2 (358.7-379.8) 1277.4 (1262.9-1288.9) 57.4 (56.2-58) 58.2 (57.4-58.9) 1760.2 (1745.2-1771.1) 8D 3P 150Mi In 358.5 (351-374.6) 1284.6 (1269.4-1298.8) 57.7 (56.6-58.3) 63.7 (63.2-64.2) 1764.5 (1748.2-1778.1) 8D 3P 150Mi Out 377.7 (368.7-389.2) 1298.3 (1285.8-1310) 58.2 (57.2-58.9) 57.2 (56.3-58.3) 1791.4 (1775-1800.8) 8D 3P 250Mi In 359.8 (351.8-368.9) 1282.9 (1272.9-1292.2) 57.7 (56.8-58.8) 64.6 (64.2-64.9) 1764.9 (1747.9-1772.7) 8D 3P 250Mi Out 367.4 (360.2-376.6) 1278.8 (1263.3-1291.8) 57.2 (55.9-58.1) 58.3 (57.5-58.9) 1761.6 (1747.7-1774.8) 8D 5P 150Mi In 362.8 (355.1-376.7) 1287 (1269.9-1299.7) 57.9 (56.6-58.6) 60.1 (59.6-60.3) 1767.7 (1749-1780.4) 8D 5P 150Mi Out 378 (371.7-388.2) 1297.8 (1284.2-1311.2) 58.2 (57.1-58.8) 57.1 (56.5-57.6) 1791.1 (1777.9-1799.3) 8D 5P 250Mi In 362 (356-372.6) 1283.4 (1268.3-1294.6) 57.7 (56.4-58.4) 61.6 (61-62.3) 1764.7 (1753.2-1774.2) 8D 5P 250Mi Out 367 (356.4-377.9) 1278.7 (1263.6-1291.5) 57 (55.9-57.9) 58.2 (57-58.9) 1761 (1744.4-1771.2)

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Transport Cost Analysis Table

Transport cost per year ($MM) Transport cost per transplant ($) Drive (%) Fly (%) Transplant cost per year ($MM) Overall cost per year ($MM) current 50.9 (50-51.6) 8444.2 (8258-8609) 49 51 1279.5 (1263.4-1291.8) 1790.6 (1771.9-1799.8) 11 Regions 62.9 (62.1-63.8) 10677.1 (10550-10834) 32 68 1265.5 (1249.5-1275.9) 1766.4 (1751.8-1779.7) 4 Districts 85.8 (84.8-86.7) 14705.7 (14657-14771) 16 84 1293 (1276.7-1304.2) 1799.3 (1785.6-1814.7) 8 Districts 71 (70.2-71.4) 12108.1 (12014-12203) 26 74 1278.5 (1264.8-1290.6) 1768.8 (1750.5-1783.8) 11R 3P 150Mi In 58.1 (57.5-59) 9786.6 (9666-9916) 39 61 1273.8 (1256.7-1286.5) 1769.7 (1750.6-1779.6) 11R 3P 150Mi Out 57.2 (56.8-57.7) 9449.1 (9354-9607) 52 48 1298.1 (1285.6-1311.1) 1790.9 (1772-1802.8) 11R 3P 250Mi In 59.3 (58.5-60.1) 10032.6 (9852-10139) 36 64 1268.9 (1253.4-1281.3) 1766.5 (1751.7-1774) 11R 3P 250Mi Out 58.3 (57.5-58.8) 9851.1 (9733-9965) 35 65 1279.3 (1262.5-1292.3) 1762.9 (1746.1-1773.5) 11R 5P 150Mi In 55.2 (54.7-55.9) 9292.3 (9223-9375) 42 58 1274 (1255.1-1286.7) 1769.3 (1749.6-1780.4) 11R 5P 150Mi Out 57.1 (56.1-57.7) 9436.2 (9320-9593) 52 48 1298.1 (1280.6-1310.9) 1791.3 (1779.1-1798.3) 11R 5P 250Mi In 57.4 (56.5-57.9) 9687.2 (9588-9839) 38 62 1269.8 (1253.5-1283) 1766.7 (1742.4-1777.5) 11R 5P 250Mi Out 58.2 (57.2-58.7) 9822.1 (9706-9952) 35 65 1279.5 (1262.6-1292.6) 1762.8 (1744.3-1773.8) 4D 3P 150Mi In 75.3 (74.5-75.8) 12740.1 (12683-12821) 26 74 1302.3 (1285.3-1313.6) 1790.9 (1774.3-1802.5) 4D 3P 150Mi Out 57 (55.9-57.9) 9420.6 (9304-9538) 52 48 1297.9 (1284.2-1312.5) 1791.5 (1780.1-1801.5) 4D 3P 250Mi In 75.4 (74.3-76.1) 12801.4 (12705-12952) 23 77 1299 (1286-1310.4) 1790.1 (1770.4-1803.8) 4D 3P 250Mi Out 58.3 (57.7-59.1) 9844.7 (9741-9943) 35 65 1278.6 (1263.5-1291.9) 1761.3 (1741.2-1772.3) 4D 5P 150Mi In 70 (69.4-70.7) 11805.6 (11714-11878) 31 69 1303.9 (1289.2-1318.5) 1791.1 (1772.1-1803.9) 4D 5P 150Mi Out 57.2 (56.5-57.9) 9447.6 (9345-9594) 52 48 1298.3 (1281.6-1312.8) 1790.9 (1775.6-1798.5) 4D 5P 250Mi In 71.2 (70.4-71.6) 12052 (11996-12141) 26 74 1298.9 (1283.5-1310.9) 1788.9 (1770.6-1802.3) 4D 5P 250Mi Out 58.2 (57.4-58.9) 9831.4 (9694-9946) 36 64 1277.4 (1262.9-1288.9) 1760.2 (1745.2-1771.1) 8D 3P 150Mi In 63.7 (63.2-64.2) 10758.9 (10684-10822) 34 66 1284.6 (1269.4-1298.8) 1764.5 (1748.2-1778.1) 8D 3P 150Mi Out 57.2 (56.3-58.3) 9446.2 (9316-9616) 52 48 1298.3 (1285.8-1310) 1791.4 (1775-1800.8) 8D 3P 250Mi In 64.6 (64.2-64.9) 10941.8 (10799-11046) 31 69 1282.9 (1272.9-1292.2) 1764.9 (1747.9-1772.7) 8D 3P 250Mi Out 58.3 (57.5-58.9) 9846.8 (9757-9944) 35 65 1278.8 (1263.3-1291.8) 1761.6 (1747.7-1774.8) 8D 5P 150Mi In 60.1 (59.6-60.3) 10113.9 (10012-10227) 38 62 1287 (1269.9-1299.7) 1767.7 (1749-1780.4) 8D 5P 150Mi Out 57.1 (56.5-57.6) 9430.8 (9332-9547) 52 48 1297.8 (1284.2-1311.2) 1791.1 (1777.9-1799.3) 8D 5P 250Mi In 61.6 (61-62.3) 10417.4 (10315-10545) 34 66 1283.4 (1268.3-1294.6) 1764.7 (1753.2-1774.2) 8D 5P 250Mi Out 58.2 (57-58.9) 9835 (9695-9972) 36 64 1278.7 (1263.6-1291.5) 1761 (1744.4-1771.2)

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Pretransplant Cost Analysis Table

Patient-months lab MELD 6-19 Patient-months lab MELD 20-29 Patient-months MELD 30-40 Pretransplant cost per year ($MM) Pretransplant cost per patient-month ($) current 746047 120183 10368 402 5947 11 Regions 768272 117674 8358 381 5911 4 Districts 789210 130866 5016 363 5817 8 Districts 781910 119735 6834 362 5856 11R 3P 150Mi In 765006 116492 8510 380 5908 11R 3P 150Mi Out 773875 117800 8198 378 5875 11R 3P 250Mi In 766818 117268 8469 381 5909 11R 3P 250Mi Out 778221 116194 7881 368 5879 11R 5P 150Mi In 762622 116765 8707 383 5917 11R 5P 150Mi Out 772546 117863 8236 378 5876 11R 5P 250Mi In 763974 117550 8620 382 5916 11R 5P 250Mi Out 777827 116248 7829 368 5880 4D 3P 150Mi In 788141 121975 5238 356 5839 4D 3P 150Mi Out 772650 117859 8275 378 5875 4D 3P 250Mi In 787993 122935 5321 358 5848 4D 3P 250Mi Out 780180 115682 7855 367 5870 4D 5P 150Mi In 784200 120668 5470 359 5855 4D 5P 150Mi Out 769819 117571 8244 377 5885 4D 5P 250Mi In 785274 121851 5542 361 5861 4D 5P 250Mi Out 779759 116064 7769 367 5878 8D 3P 150Mi In 778046 115697 6934 358 5860 8D 3P 150Mi Out 773530 117930 8236 378 5874 8D 3P 250Mi In 779101 116255 6955 360 5866 8D 3P 250Mi Out 779352 116067 7817 367 5874 8D 5P 150Mi In 774083 115905 7171 363 5876 8D 5P 150Mi Out 774285 117782 8220 378 5872 8D 5P 250Mi In 776304 116239 7053 362 5875 8D 5P 250Mi Out 778738 115837 7774 367 5878

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Pretransplant Cost Analysis Table

Patient-months lab MELD 6-19 Patient-months lab MELD 20-29 Patient-months lab MELD 30-40 Pretransplant cost per year ($MM) Pretransplant cost per patient-month ($) current 746047 120183 10368 402.4 (392.1-415.7) 5946.7 (5894-5985) 11 Regions 768272 117674 8358 381.1 (371.5-395.2) 5911.4 (5860-5950) 4 Districts 789210 130866 5016 363.2 (356.8-378.3) 5817.2 (5774-5849) 8 Districts 781910 119735 6834 362.1 (353.2-377.2) 5856 (5816-5887) 11R 3P 150Mi In 765006 116492 8510 380.4 (366.7-394.3) 5908.3 (5860-5944) 11R 3P 150Mi Out 773875 117800 8198 377.6 (369.4-389.1) 5874.7 (5796-5943) 11R 3P 250Mi In 766818 117268 8469 381.2 (370.5-392.7) 5909.1 (5859-5933) 11R 3P 250Mi Out 778221 116194 7881 368.3 (360.8-378.8) 5878.7 (5833-5910) 11R 5P 150Mi In 762622 116765 8707 382.6 (369.5-398.2) 5916.9 (5865-5955) 11R 5P 150Mi Out 772546 117863 8236 378.2 (371.7-390.8) 5875.9 (5831-5906) 11R 5P 250Mi In 763974 117550 8620 382.2 (366.6-397) 5915.5 (5861-5951) 11R 5P 250Mi Out 777827 116248 7829 368.2 (355.4-379.5) 5880 (5825-5924) 4D 3P 150Mi In 788141 121975 5238 355.5 (345.5-369) 5839.1 (5782-5866) 4D 3P 150Mi Out 772650 117859 8275 378.1 (371.8-391.5) 5874.9 (5812-5936) 4D 3P 250Mi In 787993 122935 5321 357.9 (350.2-369.6) 5847.6 (5802-5883) 4D 3P 250Mi Out 780180 115682 7855 367.1 (354.8-377.8) 5869.6 (5802-5934) 4D 5P 150Mi In 784200 120668 5470 359.1 (347.4-371.2) 5855.2 (5791-5895) 4D 5P 150Mi Out 769819 117571 8244 377.1 (369-390.3) 5884.6 (5811-5923) 4D 5P 250Mi In 785274 121851 5542 361.1 (350-375.8) 5860.7 (5810-5891) 4D 5P 250Mi Out 779759 116064 7769 367.2 (358.7-379.8) 5878.3 (5837-5915) 8D 3P 150Mi In 778046 115697 6934 358.5 (351-374.6) 5860.1 (5815-5908) 8D 3P 150Mi Out 773530 117930 8236 377.7 (368.7-389.2) 5873.5 (5807-5914) 8D 3P 250Mi In 779101 116255 6955 359.8 (351.8-368.9) 5866 (5801-5904) 8D 3P 250Mi Out 779352 116067 7817 367.4 (360.2-376.6) 5874.4 (5828-5924) 8D 5P 150Mi In 774083 115905 7171 362.8 (355.1-376.7) 5876.4 (5824-5915) 8D 5P 150Mi Out 774285 117782 8220 378 (371.7-388.2) 5871.6 (5800-5912) 8D 5P 250Mi In 776304 116239 7053 362 (356-372.6) 5875.1 (5815-5904) 8D 5P 250Mi Out 778738 115837 7774 367 (356.4-377.9) 5878.5 (5834-5918)

34

Transplant counts by lab ME LD/ PE LD group*

Lab MELD <= 15 Lab MELD 16-18 Lab MELD 19-25 Lab MELD 26-30 Lab MELD 31-33 Lab MELD 34-36 Lab MELD 37-39 Lab MELD 40 current 1675.36 856.66 1279.14 659.46 510.62 295.48 264.5 484.2 11 Regions 1606.92 624.92 1301.46 770 568.7 299.66 251.32 464.94 4 Districts 1576.52 341.52 1095.6 1084.12 653.6 344.9 274.8 463.38 8 Districts 1626.48 452.44 1225.66 902.02 606.28 320.94 263.36 467.94 11R 3P 150Mi In 1626.72 645.46 1314.2 758.72 563.72 301.6 259.26 465.98 11R 3P 150Mi Out 1688.82 715.56 1259.54 745.28 579.08 305.46 268.7 491.2 11R 3P 250Mi In 1617.34 636.56 1303.64 770.98 560.62 302.28 256.92 461.16 11R 3P 250Mi Out 1641.12 571.52 1253.94 830.28 586.04 307.06 263.2 468.68 11R 5P 150Mi In 1625.7 690.78 1302.86 743.42 558.46 303.64 254.72 465.98 11R 5P 150Mi Out 1686.9 713.94 1258.4 744.76 582.42 308.92 264.06 492.82 11R 5P 250Mi In 1620.44 680.7 1285.64 752.72 559.64 306.64 252.6 464 11R 5P 250Mi Out 1644.46 576.52 1251.2 823.18 589.38 315.76 258.1 466.16 4D 3P 150Mi In 1627.78 369.3 1090.32 1056.3 659.84 352.26 281.04 470.24 4D 3P 150Mi Out 1685.2 712.72 1265.1 745.96 577.5 307.14 266.74 492.5 4D 3P 250Mi In 1616.26 366.84 1100.44 1039.04 663.66 350.86 282.54 469.78 4D 3P 250Mi Out 1644.18 571.46 1261.86 823.9 588 303.88 266.36 462.46 4D 5P 150Mi In 1628.24 413.26 1138.08 965.16 672.68 358.88 284.7 472.26 4D 5P 150Mi Out 1687.3 714.58 1267.42 744.58 576.22 313.24 266.68 486.32 4D 5P 250Mi In 1614.76 403.16 1144.74 955.34 669.94 355.82 286.2 475.92 4D 5P 250Mi Out 1643.42 575.84 1253.82 829.9 580.52 311.24 257.08 466.32 8D 3P 150Mi In 1658.8 484.08 1238.8 884.66 603.52 321.76 263.44 464.02 8D 3P 150Mi Out 1684.52 712.32 1262.24 747.18 575.5 311.26 269.32 490.34 8D 3P 250Mi In 1648.28 475.62 1238.04 881.26 605.18 320.26 269.9 465.3 8D 3P 250Mi Out 1642.84 569.96 1262.36 828.3 586.96 304.46 260.76 466.36 8D 5P 150Mi In 1646.86 533.96 1257.3 840.64 597.4 326.9 266.98 470.92 8D 5P 150Mi Out 1694.7 711.84 1263.06 747.24 577.88 312.46 262.88 485.44 8D 5P 250Mi In 1645.2 511.38 1249.08 848.2 600.32 327.12 268.54 467.76 8D 5P 250Mi Out 1644.24 572.7 1258.28 824.62 586.84 311.8 260.44 462.56

*Mean number of transplants per category over 1 year across the 10 simulation runs for each scenario.

35

National Median Lab ME LD/ PE LD at Transplant