OBJECTIVES:

Lung transplantation (LTx) is the final treatment option for patients with terminal lung disease. Development of chronic lung allograft dysfunction (CLAD) represents one of the major adverse events after LTx. Extracorporeal photopheresis (ECP) is a cell-based immunomodulatory therapy for treating CLAD after LTx. ECP frequently changes the disease course slowing CLAD progression. The objective of this study was to characterize ECP treatment in LTx recipients in the Swiss setting and estimate annual budget impact.

METHODS:

We conducted a non-comparative cohort study at the University Hospital Zurich based on a retrospective review of patient charts treated between 2010 and 2020. Patients with new onset or existing CLAD were included and followed up for a maximum period of five years after ECP initiation. Budget impact was calculated on number of ECP treatments based on administered costs for 2022–2026.

RESULTS:

105 LTx patients with CLAD (n=49 female, mean age 50.3 years) received at least one ECP cycle and on average, 2.6 years passed between lung transplantation and development of CLAD. The first ECP treatment started on average 584 days after CLAD diagnosis. Mean number of ECP cycles was 33.82 (SD: 34, Median: 21). 15 new patients received ECP treatment each year and on average 26 patients were on maintenance treatment. Transplant activity has increased recently (24/year). Cost of ECP treatment was estimated 91,000 CHF in the first year and 72,700 CHF for maintenance. Total costs for ECP treatment in Switzerland was estimated to 2.8 to 3.4 million CHF (2.7 to 3.3 million EUR) per year in the next five years with more patients starting treatment discontinuing.

CONCLUSIONS:

The number of CLAD patients after LTx receiving ECP is projected to increase slightly over the next 5 years. Total budget impact is moderate compared to total costs of LTx patients and manageable.