Health insurance considerations for adolescent transplant recipients as they transition to adulthood
Lisa M. Willoughby
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorSumina Fukami
UCLA School of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
Search for more papers by this authorSuphamai Bunnapradist
UCLA School of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
Search for more papers by this authorJeffrey A. Gavard
Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St Louis, MO
Search for more papers by this authorKrista L. Lentine
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorKaren L. Hardinger
School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
Search for more papers by this authorThomas E. Burroughs
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorSteven K. Takemoto
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorMark A. Schnitzler
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorLisa M. Willoughby
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorSumina Fukami
UCLA School of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
Search for more papers by this authorSuphamai Bunnapradist
UCLA School of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
Search for more papers by this authorJeffrey A. Gavard
Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St Louis, MO
Search for more papers by this authorKrista L. Lentine
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorKaren L. Hardinger
School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
Search for more papers by this authorThomas E. Burroughs
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorSteven K. Takemoto
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorMark A. Schnitzler
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, St Louis, MO
Search for more papers by this authorAbstract
Abstract: The advent of improved immunosuppression and enhanced allograft outcomes has resulted in a growing number of patients taking expensive immunosuppression medications for the rest of their lives. Healthcare costs for the majority of transplantation procedures in the USA currently are covered by Medicare, but coverage ends for outpatient immunosuppression medications 36–44 months after transplantation. Two or three immunosuppressive agents typically are included in post-transplant regimens with a total annual cost that can exceed $13 000. This represents a significant financial burden for families no matter if they have adequate health insurance coverage because of co-payment obligations. Evidence suggests that some patients have reduced immunosuppression doses because of an inability to afford their medication, increasing the risk of graft failure. The purpose of this article was to review these and other issues pertaining to medical insurance coverage and transplantation, particularly for adolescent recipients as they transition to adulthood.
References
- 1 Harmon WE, Mcdonald RA, Reyes JD, et al. Pediatric transplantation, 1994–2003. Am J Transplant 2005: 5(Pt 2): 887–903.
- 2
Sarwal MM,
Cecka JM,
Millan MT,
Salvatierra O, JR. Adult-size kidneys without acute tubular necrosis provide exceedingly superior long-term graft outcomes for infants and small children: A single center and UNOS analysis. United Network for Organ Sharing.
Transplantation
2000: 70: 1728–1736.
10.1097/00007890-200012270-00012 Google Scholar
- 3 Benfield MR, Mcdonald RA, Bartosh S, HO PL, Harmon W. Changing trends in pediatric transplantation: 2001 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Transplant 2003: 7: 321–335.
- 4 Griffin KJ, Elkin TD. Non-adherence in pediatric transplantation: A review of the existing literature. Pediatr Transplant 2001: 5: 246–249.
- 5 Rianthavorn P, Ettenger RB, Malekzadeh M, Marik JL, Struber M. Noncompliance with immunosuppressive medications in pediatric and adolescent patients receiving solid-organ transplants. Transplantation 2004: 77: 778–782.
- 6 Falkenstein K, Flynn L, Kirkpatrick B, Casa-Melley A, Dunn S. Non-compliance in children post-liver transplant. Who are the culprits? Pediatr Transplant 2004: 8: 233–236.
- 7 Rianthavorn P, Ettenger RB. Medication non-adherence in the adolescent renal transplant recipient: A clinician's viewpoint. Pediatr Transplant 2005: 9: 398–407.
- 8 Dobbels F, Van Damme-Lombaert R, Vanhaecke J, De Geest S, Growing pains: Non-adherence with the immunosuppressive regimen in adolescent transplant recipients. Pediatr Transplant 2005: 9: 381–390.
- 9 Chisholm M. Increasing medication access to transplant recipients. Clin Transplant 2004: 18: 39–48.
- 10 Kory L. Nonadherence to immunosuppressive medications: A pilot survey of members of the transplant recipients international organization. Transplant Proc 1999: 31: 14S–15S.
- 11 Chisholm MA. Issues of adherence to immunosuppressant therapy after solid-organ transplantation. Drugs 2002: 62: 567–575.
- 12 Kennedy J, Erb C. Prescription noncompliance due to cost among adults with disabilities in the United States. Am J Public Health 2002: 92: 1120–1124.
- 13 Paris W, Dunham S, Sebastian A, Jacobs C, Nour B. Medication nonadherence and its relation to financial restriction. J Transpl Coord 1999: 9: 149–152.
- 14 US Department of Health and Human Services. 2005 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1995–2004. Rockville, MD: Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, 2005 (http://www.hrsa.gov/).
- 15 White PH. Access to health care: Health insurance considerations for young adults with special health care needs/disabilities. Pediatrics 2002: 110(Pt 2): 1328–1335.
- 16 Fishman E. Aging out of coverage: Young adults with special health needs. Health Aff (Millwood) 2001: 20: 254–266.
- 17 Newacheck PW, Mcmanus MA. Health care expenditure patterns for adolescents. J Adolesc Health Care 1990: 11: 133–140.
- 18 Yen EF, Hardinger K, Brennan DC, et al. Cost-effectiveness of extending Medicare coverage of immunosuppressive medications to the life of a kidney transplant. Am J Transplant 2004: 4: 1703–1708.
- 19 Kasiske BL, Cohen D, Lucey MR, Neylan JF. Payment for immunosuppression after organ transplantation. American Society of Transplantation. JAMA 2000: 283: 2445–2450.
- 20 Sanders CE, Curtis JJ, Julian BA, et al. Tapering or discontinuing cyclosporine for financial reasons – A single-center experience. Am J Kidney Dis 1993: 21: 9–15.
- 21 Hong JH, Sumrani N, Delaney V, Davis R, Dibenedetto A, Butt KM. Causes of late renal allograft failure in the ciclosporin era. Nephron 1992: 62: 272–279.
- 22 Rovelli M, Palmeri D, Vossler E, Bartus S, Hull D, Schweizer R. Noncompliance in renal transplant recipients: Evaluation by socioeconomic groups. Transplant Proc 1989: 21: 3979–3981.
- 23 Schweizer RT, Rovelli M, Palmeri D, Vossler E, Hull D, Bartus S. Noncompliance in organ transplant recipients. Transplantation 1990: 49: 374–377.
- 24 Jarzembowski T, John E, Panaro F, et al. Impact of non-compliance on outcome after pediatric kidney transplantation: An analysis in racial subgroups. Pediatr Transplant 2004: 8: 367–371.
- 25 Woodward RS, Schnitzler MA, Lowell JA, Spitznagel EL, Brennan DC. Effect of extended coverage of immunosuppressive medications by medicare on the survival of cadaveric renal transplants. Am J Transplant 2001: 1: 69–73.
- 26 Schnitzler MA, Lentine KL, Burroughs TE, Irish WD, Brennan DC, Woodward RS. Consequences of the end of medicare coverage in pediatric renal transplant recipients. Am J Transplant 2005: 5: 563.
- 27 Benfield MR. Current status of kidney transplant: Update 2003. Pediatr Clin North Am 2003: 50: 1301–1334.
- 28 Brouhard BH, Donaldson LA, Lawry KW, et al. Cognitive functioning in children on dialysis and post-transplantation. Pediatr Transplant 2000: 4: 261–267.