Utilization and Cost Analysis of Lung Transplantation and Survival After 10 years of Adopting the Lung Allocation Score (LAS)

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Abstract

Background

Lungs are allocated in the United States using the Lung Allocation Score (LAS). We investigated the effect of LAS trends on lung transplant-related costs, health care utilization, and mortality.

Methods

Utilization data from Mayo Clinic (FL and MN) from 2005-2015 were obtained from the electronic health records (N=465). Costs were categorized as 1-year post or transplant episode and standardized using 2015 Medicare reimbursement and cost-to-charge ratios. Regression analysis was used to assess the relationship of LAS to length of stay (LOS), mortality, and cost of transplant.

Results

The mean LAS at transplant increased from 45.7 to 58.3 during the study period, while the 1-year survival improved from 88.1% to 92.5%, (p<0.0001). The proportion of patients transplanted with LAS ≥ 60 increased from 16.9% to 33.3%. Post-transplant, overall and ICU LOS increased with increasing LAS. Patients with higher LAS had substantially higher transplant episode costs. An increase of LAS at transplant by 10 points increased inflation-adjusted costs by 12.0% (95% CI: 9.3%-14.5%).

Conclusions

The mean LAS at transplant has significantly increased over time associated with increases in LOS, resource utilization and cost. LAS has not jeopardized overall survival, but a high LAS (>60) at transplant is associated with increased mortality.

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