Purpose

Bronchiolitis obliterans syndrome (BOS), affects nearly 50% of lung transplant recipients within 5 years and is the leading cause of death for patients who survive at least one year post transplant. The impact of BOS on healthcare resource use (HRU) and costs is not well understood. The aim is to quantify the economic burden of BOS in the US.

Methods

A retrospective analysis of claims data for commercially insured patients age <65 who underwent lung transplantation between 1/1/2006 and 9/30/2018 was performed. Transplantation was identified using International Classification of Disease (ICD) and Common Procedure Terminology (CPT) codes. Patients were observable 12+ months pre- and post- transplantation. BOS patients were identified using diagnosis codes for severe lung disease 1+ years post-transplant and followed longitudinally. Mean monthly per patient HRU following BOS diagnosis was calculated by CLAD stage. Mean costs, calculated by HRU type, were multiplied by HRU rates to estimate costs by CLAD stage. Costs were those paid by commercial payers in the US.

Results

Among 134 patients who met criteria for BOS following lung transplantation, healthcare costs were substantially higher with CLAD progression. Patients in CLAD 4 had much higher mean per patient monthly costs ($5,042) compared with lower stages (CLAD 1: $554; CLAD 2: $1,080; CLAD 3: $1,724). Inpatient admissions were responsible for most costs for patients in CLAD 3 and 4, while outpatient services accounted for virtually all costs in CLAD 1 and 2. Drug costs were higher for patients in CLAD 2 vs. 1 ($9,917 vs. $6,145). On an annual basis, mean per patient costs increased from $6,658 in CLAD stage 1 to $60,508 in CLAD stage 4 (Figure).

Conclusion

BOS after lung transplantation imposes a large economic burden on healthcare systems and patients that increases substantially in later CLAD stages. Early diagnosis and therapies aimed at slowing disease progression may reduce economic burden associated with BOS.