Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: A retrospective cohort study

John Kenneth Peel; Shaf Keshavjee; David Naimark; Mingyao Liu; Lorenzo Del Sorbo; Marcelo Cypel; Kali Barrett; Eleanor M Pullenayegum; Beate Sander

doi:10.1016/j.healun.2022.10.016

Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: A retrospective cohort study

J Heart Lung Transplant. 2023 Mar;42(3):356-367. doi: 10.1016/j.healun.2022.10.016. Epub 2022 Nov 9.

Authors

John Kenneth Peel¹, Shaf Keshavjee², David Naimark³, Mingyao Liu², Lorenzo Del Sorbo⁴, Marcelo Cypel², Kali Barrett⁵, Eleanor M Pullenayegum⁶, Beate Sander⁷

Affiliations

¹ Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada. Electronic address: john.peel@mail.utoronto.ca.
² Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
³ Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁴ Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵ Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Ontario, Canada; Public Health Ontario, Ontario, Canada. Electronic address: Beate.sander@uhnresearch.ca.

PMID: 36411188
DOI: 10.1016/j.healun.2022.10.016

Abstract

Introduction: Ex-vivo lung perfusion (EVLP) has improved organ utilization for lung transplantation, but it is not yet known whether the benefits of this technology offset its additional costs. We compared the institutional costs of lung transplantation before vs after EVLP was available to identify predictors of costs and determine the health-economic impact of EVLP.

Methods: We performed a retrospective, before-after, propensity-score weighted cohort study of patients wait-listed for lung transplant at University Health Network (UHN) in Ontario, Canada, between January 2005 and December 2019 using institutional administrative data. We compared costs, in 2019 Canadian Dollars ($), between patients referred for transplant before EVLP was available (Pre-EVLP) to after (Modern EVLP). Cumulative costs were estimated using a novel application of multistate survival models. Predictors of costs were identified using weighted log-gamma generalized linear regression.

Results: A total of 1,199 patients met inclusion criteria (352 Pre-EVLP; 847 Modern EVLP). Mean total costs for the transplant hospitalization were $111,878 ($94,123-$130,767) in the Pre-EVLP era and $110,969 ($87,714-$136,000) in the Modern EVLP era. Cumulative five-year costs since referral were $278,777 ($82,575-$298,135) in the Pre-EVLP era and $293,680 ($252,832-$317,599) in the Modern EVLP era. We observed faster progression to transplantation when EVLP was available. EVLP availability was not a predictor of waitlist (cost ratio [CR] 1.04 [0.81-1.37]; p = 0.354) or transplant costs (CR 1.02 [0.80-1.29]; p = 0.425) but was associated with lower costs during posttransplant years 1&2 (CR 0.75 [0.58-1.06]; p = 0.05) and posttransplant years 3+ (CR 0.43 [0.26-0.74]; p = 0.001).

Conclusions: At our center, EVLP availability was associated with faster progression to transplantation at no significant marginal cost.

Keywords: Ex-Vivo Lung perfusion; Organ preservation; economic evaluation; health care costs; lung transplantation.

MeSH terms

Cohort Studies
Hospital Costs*
Humans
Lung
Lung Transplantation*
Ontario / epidemiology
Organ Preservation
Perfusion
Retrospective Studies