Costs of End-of-Life Hospitalizations for Individuals with Pulmonary Diseases in the United States

BACKGROUND:Lung transplant is a life-saving intervention for individuals with advanced lung disease but is costly and resource-intensive. To investigate the cost-effectiveness of lung transplant as a treatment option in pulmonary disease, we must understand costs attributable to end-of-life hospitalizations for end-stage lung disease. RESEARCH QUESTION:What are the costs associated with end-of-life hospitalizations for individuals with pulmonary disease and how have these trends changed over time? STUDY DESIGN AND METHODS:Adults aged 18-74 with hospitalization data in the Cost and Utilization Project National Inpatient Sample data from 2009-2019 with a pulmonary disease admission were included in this analysis. Those with a history of lung transplant were excluded. ICD codes were used to identify pulmonary disease admissions, complications, and procedures and interventions. Total charges were calculated for hospitalizations and stratified by patient status at time discharge. Trends in charges over time were assessed by demographic and hospital factors. RESULTS:109,924 (4.1%) hospital admissions for pulmonary disease resulted in in-hospital mortality. Those with obstructive lung disease accounted for 94.1% of hospitalizations and 88.1% cases of in-hospital mortality. Estimated costs for end-of-life hospitalizations cost $29,981 on average with wide variation in cost by diagnosis and procedure utilization. Inpatient costs were highest for younger individuals who received more procedures. Among the most expensive admissions, mechanical ventilation accounted for the greatest proportion of interventions. Significant increases in the use of mechanical ventilation, extracorporeal membrane oxygenation, and dialysis occurred over the time period. The rate of hospital transfers increased with a proportionately greater increase across admissions resulting in in-hospital mortality. INTERPRETATION:Costs accrued during end-of-life hospitalizations vary across individuals but represent a significant healthcare cost that can be averted for selected individuals who undergo lung transplant. These costs should be considered in studies of cost-effectiveness in lung transplantation.