NEW YORK (Reuters Health) Mar 07 - Immediately after undergoing an organ transplant, the 1-year graft survival rate among children and adolescents has risen to more than 90% in recent years. Unfortunately, these exemplary outcomes are followed by increasing rates of graft loss, investigators report in the March issue of Pediatric Transplantation.
Dr. Mark A. Schnitzler, from the St. Louis University School of Medicine, and his associates believe that non-compliance is an important cause of organ rejection, and non-compliance is often related to patients' inability to pay for immunosuppressive agents, which are required for the remainder of the patient's life.
"Immunosuppressive drugs that prevent organ rejection are incredibly expensive, sometimes more than $13,000 a year," Dr. Schnitzler comments in a university press release.
He and his associates have reviewed the financial aspects of continuing graft survival.
Medicare pays for most organ transplants in the U.S. However, coverage of immunosuppressant drugs ends 36 to 44 months after surgery or when the patient reaches adulthood. Many patients, especially young adults, can not afford to pay for these drugs. Moreover, only about 30% of young adults have health insurance.
The situation is also difficult for dependent children. "Even for families with insurance, the co-payments can be a huge financial burden," Dr. Schnitzler adds.
For individuals who have employer-sponsored and private health insurance, coverage ends once a patient reaches a lifetime maximum amount stipulated by their policies.
As a result of these circumstances, many transplanted organs are rejected and patients' lives are shortened.
One study of 1001 kidney recipients found that graft loss more than doubled when Medicare coverage ended. Once the transplanted kidney no longer works, the risk of death increases 9-fold.
The cost to society of failed organ transplants is also high. Dr. Schnitzler's group refers to a study by E. F. Yen et al. that found, "functioning transplants are 10 times less expensive than allowing them to fail during the year following failure. The maintenance cost for a transplant recipient has been estimated to be $13,749 per year while the first-year cost of returning to dialysis after graft failure is $137,930."
Dr. Schnitzler and his colleagues conclude that new public policies requiring lifetime health care coverage for organ transplant recipients would be cost-effective, and would prolong patients' longevity and their productivity.
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