Impact of the lung allocation score on resource utilization after lung transplantation in the United States

Background: The United States lung allocation score (LAS) allows rapid organ allocation to higher acuity patients. Although, wait-list time and wait-list mortality have improved, the costs of lung transplantation (LTx) in these higher acuity patients are largely unknown. We hypothesize that LTx in high LAS recipients is associated with increased charges and resource utilization.

Methods: Clinical and financial data for LTx patients at our institution in the post-LAS era (May 2005 to 2009) were reviewed with follow-up through December 2009. Patients were stratified by LAS quartiles (Q). Total hospital charges for index admission and all admissions within 1 year of LTx were compared between Q4 vs Q1-3 using rank-sum and Kruskal-Wallis tests, as charge data were not normally distributed.

Results: Eighty-four LTxs were performed during the study period. Sixty-three (75%) patients survived 1 year; 10 (11.9%) died during the index admission. Median LAS was 37.5 (interquartile range [IQR] 34.3 to 44.8). LAS quartiles were: Q1, 30.1 to 34.3, n = 21; Q2, 34.4 to 37.5, n = 21; Q3, 37.6 to 44.8, n = 21; and Q4, 44.9 to 94.3, n = 21. Charges for index admission were: Q4, $276,668 (IQR 191,301 to 300,156) vs Q1-3, $153,995 (IQR 129,796 to 176,849) (p < 0.001). Index admission median length of stay was greater in Q4 (Q4: 35-day IQR 23 to 46 vs Q1-3: 15-day IQR 11 to 22, p = 0.003). For 1-year charges: Q4, $292,247 (IQR 229,192 to 421,597) vs Q1-3, $188,342 (IQR 153,455 to 252,045) (p = 0.002). Index admission and 1-year charges in Q4 were higher than for other quartiles when examined individually.

Conclusions: This is the first study to show increased charges in high LAS patients. Charges for the index admission and hospital care in the year post-LTx were higher in the highest LAS quartile compared with patients in the lowest 75% of LAS.