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Bronchiolitis Obliterans Syndrome and Additional Costs of Lung Transplantation^*

^* From the Department of Pulmonology (Drs. van den Berg, Postma, van der Bij, and Koëter) and Office for Medical Technology Assessment (Drs. van Enckevort and TenVergert), University Hospital, Groningen, the Netherlands.

Correspondence to: Jan W. K. van den Berg, MD, PhD, Department of Pulmonology, Isala Clinics, PO Box 10.500, 8000 GM Zwolle, the Netherlands; e-mail: j.w.k.van.den.berg{at}isala.nl

Study objectives: The influence of bronchiolitis obliterans syndrome (BOS) on costs after lung transplantation was investigated by comparing the costs of patients with and without this condition.

Design: Follow-up costs were prospectively investigated in a medical technology assessment of the Dutch Lung Transplant Program, in relation to the development of the BOS. First, average follow-up costs per week per patient were compared between patients who did or did not develop BOS. Second, in the BOS group, these costs were compared before and after the onset of BOS.

Setting: Dutch Lung Transplant Program, University Hospital of Groningen.

Results: Data on 53 patients (37 patients without BOS and 16 with BOS) who underwent transplantation between November 1990 and April 1995 were available. The average follow-up time of these 53 patients was 1.5 years. The follow-up costs amounted to an average (in Dutch guilders [Dfl]) of 1,774/wk for non-BOS patients, compared to 3,072/wk for BOS patients (+ 73%; p = 0.002; one Dfl = 50 cents US currency). This difference in costs was largely accounted for by an increase in used health-care resources, in particular hospitalization and medication. For the BOS patients, the average costs per week before and after the onset of BOS were 1,941 Dfl and 2,422 Dfl, respectively.

Conclusion: BOS is associated with substantial extra costs. These findings reemphasize the need to focus efforts on prevention of BOS to enhance the cost-effectiveness of lung transplantation.

Key Words: bronchiolitis obliterans • cost analysis • lung transplantation

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