The cost of lung transplantation and the quality of life post-transplant.
As recently as the 1992 Report of the American Thoracic Society Workshop on Lung Transplantation, no QOL facts were given and no knowledge gaps related to QOL outcomes were cited. Even at the present time, the information in that area is based on a relatively small set of preliminary reports. Current information indicates that successful lung transplantation largely reverses the energy and physical mobility deficits reported by transplant candidates and that those improvements are sustained for at least several years after transplant. Recipients report improved health perceptions, fewer problems, and greater life satisfaction than candidates. The type and amount of QOL benefit appear to differ by underlying lung disorder, and recipients who develop obliterative bronchiolitis syndrome experience declines in QOL. Lung transplantation surgery is an expensive procedure initially, and costs remain high during follow-up. Little information is available on long-term QOL outcomes or cost-effectiveness. There is a compelling rationale for QOL research in lung transplantation. At the present time, some of the most challenging problems in transplantation, such as the selection of optimal timing for transplant and choice of immunosuppression medications, do not appear to have clear-cut survival or clinical benefits. Determination of the best approach to such problems is likely to hinge on patients' perceptions of the risk-to-benefit ratio, measured by their perceived QOL. Findings from QOL research need to be developed into interventions to enhance patient outcomes. As noted by Whitehead, QOL and potentially lethal noncompliance may be linked. Can we develop immune suppressive protocols that maintain clinical benefits while minimizing QOL burdens? Pilot studies suggest that QOL can be enhanced prior to transplant, and that health-related QOL prior to transplant may predict survival and clinical outcomes. As noted by Ramsey et al, multicenter studies are needed to achieve sufficient numbers for multivariate and subset analyses and to address issues such as the impact of diagnosis (indication for transplant) on QOL outcomes and cost-effectiveness. QOL and cost measures must be incorporated into large, longitudinal, multicenter clinical trials and observational studies to address those issues.
Gross
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College of Pharmacy, University of Minnesota, Minneapolis, USA.
Raghu
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D000203:Activities of Daily Living; D000328:Adult; D001294:Attitude to Health; D002648:Child; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D016040:Lung Transplantation / Q000191:economics* / Q000523:psychology*; D017060:Patient Satisfaction; D011788:Quality of Life; D016896:Treatment Outcome