The economic implications of noninvasive molecular testing for cardiac allograft rejection

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.