OBJECTIVES

Bronchiolitis Obliterans Syndrome (BOS), a common complication after lung transplantation, is a rapidly progressive obstructive airway disease characterized by T-cell mediated inflammation and fibrosis, leading to respiratory failure and death. BOS typically manifests at least 1 year post transplantation and affects an estimated 48% of patients within 5 years of transplant. The economic burden of BOS following lung transplantation is not well understood.

METHODS

The data source for this retrospective longitudinal study was IQVIA PharMetricsPlus commercial claims database; the study timeframe was 01/01/2006-09/30/2018. Study patients were lung transplant recipients age 18-64y with evidence of BOS 1+ years after transplantation. There is no BOS-specific diagnosis code; consequently, patients were identified as those with 2+ claims with a diagnosis for serious lung disease at least 2 months apart and 1+ years after transplant. Hospitalizations were attributed to the admission month. Outcome measures were mean per-patient monthly costs paid by insurers and healthcare resource utilization (HRU) starting 1 year post-transplant. Monthly costs and HRU were summed to estimate per-patient costs and HRU in each year.

RESULTS

Among 130 patients who met study criteria, 65% were male; mean age was 52.1y (±0.76); all were observable at least 28 months after transplantation, including 46 observable for 60 months. Mean per-patient monthly costs ranged from $3,951 (±6,758.11) to $403,270 (±330,175.24), with the highest rates of hospitalizations with ICU stays (1.09 ±0.47) in the most expensive month. When annualized, per-patient costs ranged from $103,635 (year 4) to $633,375 (year 1). Inpatient admissions represented 77%, 47% and 52%, and 39% of costs in the second, third and fourth post-transplant years, respectively.

CONCLUSIONS

Lung transplantation patients who develop BOS incur healthcare costs that remain high over time. While lung transplantation is intended as curative, the economic burden of this common complication is substantial and in addition to the costs of transplant.