Introduction: Health disparities are well-documented within pediatric liver diseases. Disparity patterns in healthcare costs can provide insights into factors that influence outcomes for marginalized groups. My objective was to investigate racial and ethnic disparities in hospitalization costs associated with first-time isolated pediatric liver transplants and explore contributing factors.

Methods: Utilizing linkage of national administrative data (Pediatric Health Information System) to the Scientific Registry of Transplant Recipients, index hospitalization records for primary, isolated pediatric liver transplants between 2015-2020 were identified. Records were categorized by race (White, Black, Other) and ethnicity (Hispanic, non-Hispanic). Cost was modeled using multivariable mixed-effects generalized linear regression. A baseline model used race and ethnicity as predictors for unadjusted marginal cost estimation, then subsequently built in stepwise fashion to identify explanatory variables.

Results: 1777 records were included for analysis. At baseline, compared to White children, Black children incurred approximately $30,000 higher in total costs (p=0.017). This was not explained by demographic variables, pre-transplant characteristics, or post-transplant complications. Additionally controlling for length of stay (LOS) significantly reversed this finding, estimating $19,000 lower costs for Black children (p=0.006). Application of this model to sub-costs identified lower costs for Black children in labs (p=0.003), imaging (p=0.063), and an “other” (p=0.02) category which includes unit costs, nutritional assessments, social services, care coordination, and patient education.

Conclusions: These findings suggest Black children receive less medical evaluation or ancillary services compared to White children with similar characteristics. The patterns identified here should be analyzed further using individual charge data.