HAND TRANSPLANT REHABILITATION FINANCIAL CONSIDERATIONS

Selena McGill¹, Ashley Buren Emrich¹, Laurie Newsome¹, Anne Hodges¹, Christina Kaufman¹.

¹Department of Hand Therapy, Christine M Kleinert Institute, Louisville, KY, USA.

Purpose: Hand transplant rehabilitation costs have yet to be analyzed at our center with a comparison of financial considerations for unilateral versus bilateral transplants. We compared increased physical/occupational therapists for rehabilitation, administrative and splinting costs.

Methods: Collection of financial data was compiled by time spent each therapist/day, average wages/hour, combined with using the CPT codes charges to determine cost of therapy. Costs included weekend work early post-transplant, transitioning to an average three hours of therapy/day, five days a week for the unilateral recipients and four hours/day, five days a week for the bilateral hand recipient. Wweekend therapy was stopped to allow the patient time to rest due to fatigue.

Results: Using the CPT code charge system, the average cost of therapy for the unilateral recipients was $236/ hour, average of 226 hours of therapy, totaling $53,336.00/unilateral recipient. The bilateral recipient direct therapy totaled $63,360.00; 260 hours of physical/occupational therapy treatment. Administrative and splinting costs were approximately $2000.00 each, for unilateral. The primary variable affecting cost variation was post transplant complications. In the case of our bilateral transplant recipient, complications which extended his stay from 90 days to 126 days, decreased his direct therapy hours and increased administrative costs. Vascular complications resulted in the need for multiple new splints, with the cost totaling $7000.00. Programs which are transplanting recipients from out of state may consider travel and housing costs to train the local therapist who will be working with the patient in his/her hometown.

Conclusions: At our center, hand transplantation is still considered an experimental protocol,although some grand funding is available, much of the cost is borne by our Institution. As this therapeutic modality becomes a standard of care, further research is needed to determine if the amount of resources currently used is an absolute requirement. We may find lesser amounts of therapy, will suffice, if combined with the use of computers to monitor home exercise and activity compliance, to reduce the financial burden on therapy departments.