@article{68add9e9240947579288286b83031ba0,
title = "Utilization and Cost Analysis of Lung Transplantation and Survival after 10 Years of Adapting the Lung Allocation Score",
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, healthcare utilization, and mortality. Methods. Utilization data from Mayo Clinic (Florida and Minnesota) from 2005 to 2015 were obtained from the electronic health records (N = 465). Costs were categorized as 1-year posttransplant 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, whereas the 1-year survival improved from 88.1% to 92.5% (P < 0.0001). The proportion of patients transplanted with LAS of 60 or greater increased from 16.9% to 33.3%. Posttransplant, overall, and intensive care unit 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% confidence interval, 9.3%-14.5%). Conclusions. The mean LAS at transplant has significantly increased over time associated with increases in LOS, resource utilization and cost. Lung allocation score has not jeopardized overall survival, but a high LAS (>60) at transplant is associated with increased mortality.",
author = "Keller, {Cesar A.} and Gonwa, {Thomas A.} and White, {Launia J.} and Rucci, {March E.} and Visscher, {Sue L.} and Kennedy, {Cassie C.} and Daly, {Richard C.} and Naessens, {James M.}",
note = "Funding Information: Accepted 7 March 2018. 1Department of Transplantation, Mayo Clinic, Jacksonville, FL. 2Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota and Jacksonville, FL. 3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN. 4Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN. 5Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN. This work was supported in part by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, an unrestricted grant by United Therapeutics and by NHLBI of the NIH under award number K23 HL 128859 (C.C.K., principal investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Descriptor Number: 16.2. Funding Information: This work was supported in part by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, an unrestricted grant by United Therapeutics and by NHLBI of the NIH under award number K23 HL 128859 (C.C.K., principal investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Descriptor Number: 16.2. Publisher Copyright: {\textcopyright} 2019 Wolters Kluwer Health, Inc.",
year = "2019",
month = mar,
day = "1",
doi = "10.1097/TP.0000000000002227",
language = "English (US)",
volume = "103",
pages = "638--646",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "3",
}