Original Clinical Science
Contribution of skin cancer to overall healthcare costs of lung transplantation in Queensland, Australia

https://doi.org/10.1016/j.healun.2023.05.014Get rights and content

Background

Skin cancers are a major source of morbidity in lung transplant recipients, but the relative costs associated with their treatment are unknown.

Methods

We prospectively followed 90 lung transplant recipients from enrollment in the Skin Tumors in Allograft Recipients study in 2013–2015, until mid-2016. We undertook a cost analysis to quantify the health system costs relating to the index transplant episode and ongoing costs for 4 years. Linked data from surveys, Australian Medicare claims, and hospital accounting systems were used, and generalized linear models were employed.

Results

Median initial hospitalization costs of lung transplantation were AU$115,831 (interquartile range (IQR) $87,428–$177,395). In total, 57 of 90 (63%) participants were treated for skin cancers during follow-up at a total cost of AU$44,038. Among these 57, total government costs per person (mostly of pharmaceuticals) over 4 years were median AU$68,489 (IQR $44,682–$113,055) vs AU$59,088 (IQR $38,190–$94,906) among those without skin cancer, with the difference predominantly driven by more doctors’ visits, and higher pathology and procedural costs. Healthcare costs overall were also significantly higher in those treated for skin cancers (cost ratio 1.50, 95%CI: 1.09, 2.06) after adjusting for underlying lung disease, age on enrollment, years of immunosuppression, and the number of treated comorbidities.

Conclusions

Skin cancer care is a small component of overall costs. While all lung transplant recipients with comorbidities have substantial healthcare costs, those affected by skin cancer incur even greater healthcare costs than those without, highlighting the importance of skin cancer control.

Section snippets

Overview

Using a population-based cohort, we undertook a cost analysis to quantify the health system and patient out-of-pocket costs for lung transplant recipients following transplantation. We separately described the costs relating to the index hospitalization for transplantation (n = 45) but focus on the posttransplant total costs over 4 years (at various periods after transplant) for 90 patients. All patients had complete cost data for 4 years. The study was approved by the Human Research Ethics

Results

The mean age of participants at enrollment was 48.3 (standard deviation (SD) 12.3) years. Those with an initial diagnosis of cystic fibrosis (n = 45) were significantly younger (mean 40 vs 57 years old) than those with other lung diagnoses (Table 1). In total, 55 (61%) participants had received their transplant within 5 years of study enrollment, 20 (22%) were 6 to 10 years posttransplant, and 15 (17%) were more than 11 years posttransplant. Fifty-one (57%) participants were male, and 72 (80%)

Discussion

This study shows the healthcare costs for lung transplant recipients to governments, and patients are high for the initial transplant and ongoing care. Although lung transplant recipients are at high risk of hazardous skin cancers, a small cost proportion (0.6%) of total costs were incurred for the management of skin cancers. However, these total costs occurred over 4 years in a relatively high proportion of participants (60%), and those with skin cancers experienced 50% higher overall

Disclosure statement

This study was supported by the National Health and Medical Research Council (NHMRC) of Australia (grants 552429 and 1073898). The funder had no role in the collection of data, its analysis and interpretation, or in the right to approve or disapprove publication of the finished manuscript.

CRediT authorship contribution statement

LG performed the statistical modeling and data analysis, and produced the first written draft of the paper. LG and AG contributed to conceptualization, data analysis interpretation, writing, and editing. AG obtained the grant funding for the STAR study. PH and DC provided clinical expertise, knowledge, and intellectual inputs, obtained grants, and assisted with data collection. LG contributed to data cleaning and management. All authors were involved in writing and editing, and approved the

Acknowledgments

We sincerely thank Upekha Liyanage and Astrid Rodriguez-Acevedo for their assistance in data management and analysis during the earlier stages of this work.

References (24)

  • P. Deb et al.

    Modeling health care expenditures and use

    Annu Rev Public Health

    (2018)
  • N. Pandeya et al.

    Basal cell carcinomas in organ transplant recipients versus the general population: clinicopathologic study

    Arch Dermatol Res

    (2022)
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