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1 From the Department of Medicine, and the Department of Health Services, University of Washington, Seattle
2 From the Department of Health Services, University of Washington, Seattle
3 From the Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
4 From the Department of Medicine, University of Washington, Seattle
5 From the Division of Cardiothoracic Surgery, University of Washington, Seattle
Objective: Lung transplantation is one of the fastest-growing solid organ transplant procedures in the world, yet its cost-effectiveness is unknown. We compared the costs and outcomes of the first 25 patients who received lung transplants at the University of Washington with 24 patients currently on the lung transplant waiting list.
Design: Inpatient and outpatient charges were obtained from the hospital billing service and home health agencies. Quality-adjusted life year scores (QALYs) were computed from the following: (1) utility scores obtained through standard gamble interviews, and (2) published survival data from an international lung transplant registry and from studies of patients on lung transplant waiting lists.
Results: Transplantation charges averaged $164,989 (median, $152,071). Average monthly charges posttransplant were $11,917 in year 1 and $4,525 thereafter, vs $3,395 for waiting-list patients. Posttransplant utility scores were significantly higher than waiting-list scores (0.80 vs 0.68; p<0.001). Life expectancy was not greater for lung transplant vs waiting-list patients (5.89 vs 5.32 years; p>0.05), although quality-adjusted life expectancy did improve significantly. After converting charges to costs, the incremental cost per QALY gained for posttransplant compared with waiting-list patients was $176,817.
Conclusions: Lung transplantation is very expensive, although it can substantially improve quality of life. Two-thirds of care costs are incurred after transplantation. The principal barriers to cost-effectiveness at present are the high cost of postrecovery care and marginal gains in life expectancy compared with conservative care.
Key Words: cost-effectiveness • lung transplantation • quality-adjusted life years
Submitted on December 21, 1994
Accepted on June 21, 1995
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