Objective  To analyze financial burden after pediatric liver transplantation (PLT). By providing data, it will contribute to health economic evaluations and optimization of the allocation of medical resources for organ transplantation in China.

Methods  The basic information and payment data of PLT cases from 2017 to 2021 in Beijing Friendship Hospital, Capital Medical University were retrospectively collected to analyze the direct medical cost. Convenience sampling method was used to select guardians of PLT case in outpatient and inpatient follow up for a questionnaire-based survey. Direct non-medical costs and indirect costs were obtained by questionnaire survey and human capital method. The subjective feelings of the patients’ families about the financial burden were investigated. The changing trend, composition and influencing factors of financial burden in the 5 years were analyzed.

Results  A total of 683 children were included, 234 valid questionnaires were collected. In the 5 years, the direct medical costs of follow-up patients after PLT exhibited a trend first increasing and then decreasing. And the drug costs accounted for the highest proportion, accounting for 45.27%-57.33% of outpatients. In 2021, the per capita financial burden of pediatrics after PLT was 17 870.12 yuan (95%CI 16 370.87 to 19 369.37), of which the direct medical cost was 13 321.65 yuan (95%CI 11 818.46 to 14 824.85), the direct non-medical cost was 2 248.05 yuan (95%CI 2 169.86 to 2 326.24), and the indirect cost was 2 300.42 yuan (95%CI 2 253.43 to 2 347.40). The economic burden was inversely correlated with the duration of follow-up after transplantation (P<0.05). From the whole society view, the financial burden of pediatric patients with special medical insurance was heavier than other types of medical insurance (P<0.05).

Conclusion  PTL brings a heavy financial burden for families and society. The cost of medicine is the major factor. It is expected that the government will continue to optimize the allocation of medical insurance resources and pharmaceutical centralized purchase of immunosuppressive agents to reduce the economic burden of pediatric liver transplantation.

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