OBJECTIVES: Bronchiolitis Obliterans Syndrome (BOS), a rapidly progressive obstructive airway disease, affects up to half of all lung transplant patients within 5 years of transplantation and leads to respiratory failure and death. This study quantified healthcare resource use (HRU) and costs in Medicare lung transplant patients who developed BOS.

METHODS: The data source for this retrospective longitudinal study was the Medicare Limited Dataset; study timeframe was 01/01/2010-12/31/2017. Study participants were age-eligible (>=65yrs) and disability-eligible (<65yrs) Medicare beneficiaries with fee-for-service coverage for 1+ years before and after BOS index diagnosis (ICD-9: 491.8, 491.9, 515, 516.34, 561.8; ICD-10: J41.8, J42, J84.09, J84.89, and J84.115), and evidence of prior lung transplantationOutcome measures were patient characteristics, mean per-patient costs paid by Medicare, and HRU in the first year after BOS diagnosis. Analyses were repeated for patients who survived 2 and 3 years.

RESULTS: Among 4,154 patients, 54% were male; mean age was 58.8yrs (SD:12.4), with a majority disability-eligible (n=2,394; 57.6%). Mean annual per-patient costs were $49,744 (SD:84,146) in the first year post-BOS diagnosis. Among those who survived, costs decreased to $25,426 (SD:57,065; N=3,339) in year 2 and $12,546 (SD:37,288; N=2,005) in year 3. Inpatient hospitalization per-patient costs averaged $36,655 (SD:77,258) in the first year post-BOS diagnosis, but were lower in year 2 ($17,830 [SD:50,933]) and year 3 ($11,157 [SD:37,355]). Inpatient admissions averaged 1.8 (SD:2.3) per-patient in the first post-diagnosis year, decreasing to 0.7 (SD:1.5) in year 3. Mean length of hospital stay was 25.8 (SD:35.8), 20.6 (SD:29.5), and 18.0 (SD:25.5) days in years 1, 2 and 3, respectively.

CONCLUSIONS: The majority of Medicare lung transplant patients who develop BOS are <65yrs, disability-eligible patients. Hospitalizations are lengthy and underlie most BOS patient costs. The yearly decline in costs reflects decreasing hospitalization rates and may reflect survival of healthier patients.