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

Abstract

Background: Skin cancers are a major source of morbidity in lung transplant recipients but relative costs associated with their treatment are unknown. Methods: We prospectively followed 90 lung transplant recipients from enrolment in the Skin Tumours in Allograft Recipients study in 2013 to 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 four years. Linked data from surveys, Australian Medicare claims and hospital accounting systems were used and generalized linear models were employed. Results: Median initial hospitalisation costs of lung transplantation were AU$115,831 (interquartile range (IQR) $87,428 - $177,395). In total, 57/90 (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 four 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 enrolment, years of immunosuppression and number of treated comorbidities. Conclusion: 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.