Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Precision Health Economics and Outcomes Research, Boston, MA, USA.
J Med Econ. 2022 Jan-Dec;25(1):650-659. doi: 10.1080/13696998.2022.2071065.
Chronic lung allograft dysfunction (CLAD), a common complication of lung transplantation, is the leading cause of death for lung transplant recipients. While data on lung transplant costs are available, the impact of CLAD on healthcare resource use (HRU) and cost is not well understood. The primary objective was to quantify the HRU and costs of CLAD in the US using real-world data.
A longitudinal retrospective analysis was performed of commercial claims data from the IQVIA PharMetrics Plus database for patients aged 18-64 who underwent lung transplantation between January 1, 2006 and September 30, 2018. Lung transplantation was identified using International Classification of Disease and Common Procedure Terminology procedure codes. Patients studied were observable for at least 12 months before and after transplantation. Patients who developed CLAD were identified using novel, diagnosis codes for incident lung disease at least one year following transplantation. Descriptive analyses were conducted to assess the study's outcomes prior to and following a CLAD diagnosis. All-cause HRU and costs, the study's primary outcomes, leading up to and following CLAD diagnosis were calculated.
Among 129 transplant patients who developed CLAD, healthcare costs were substantially higher in the year following diagnosis ($198,113), compared to the year leading to diagnosis ($85,276). Inpatient admissions were responsible for most costs in years 1 and 2 following diagnosis ($99,372 and $83,348 respectively). Drug costs were higher in the 12 months post-index, compared to the 12 months pre-index ($3,600 vs $2,527).
Claims data do not include clinical data, have limits determining loss of follow-up, and do not provide granularity to determine disease severity. Also, there is no ICD-10-CM code specific to CLAD or BOS.
CLAD after lung transplant is associated with substantial HRU and costs. Further work is needed to develop interventions that reduce this impact.
慢性肺移植物功能障碍（CLAD）是肺移植的常见并发症，也是肺移植受者死亡的主要原因。虽然有关于肺移植成本的数据，但 CLAD 对医疗资源使用（HRU）和成本的影响尚不清楚。主要目的是使用真实世界的数据量化美国 CLAD 的 HRU 和成本。
对 IQVIA PharMetrics Plus 数据库中的商业索赔数据进行了一项纵向回顾性分析，该数据库纳入了 2006 年 1 月 1 日至 2018 年 9 月 30 日期间接受肺移植的 18-64 岁患者。使用国际疾病分类和通用程序术语程序代码识别肺移植。研究患者在移植前后至少可观察 12 个月。使用至少在移植后一年出现的新的、用于诊断肺疾病的诊断代码来识别发生 CLAD 的患者。在 CLAD 诊断前后进行描述性分析，以评估研究结果。所有原因的 HRU 和成本是本研究的主要结果，在 CLAD 诊断前后进行了计算。
在 129 名发生 CLAD 的移植患者中，与诊断前一年相比（85276 美元），诊断后一年的医疗保健费用显著更高（198113 美元）。在诊断后 1 年和 2 年，住院治疗分别占大部分成本（分别为 99372 美元和 83348 美元）。与指数前 12 个月相比，索引后 12 个月的药物费用更高（3600 美元比 2527 美元）。
索赔数据不包括临床数据，在确定失访方面存在限制，并且无法提供确定疾病严重程度的粒度。此外，没有特定于 CLAD 或 BOS 的 ICD-10-CM 代码。
肺移植后 CLAD 与大量的 HRU 和成本相关。需要进一步努力开发减少这种影响的干预措施。
