title: Lung transplantation in the spotlight: Reasons for high-cost procedures.
abstract: Hospital treatment costs of lung transplantation are insufficiently analyzed. Accordingly, it remains unknown, whether current Diagnosis Related Groups, merely accounting for 3 ventilation time intervals and length of hospital stay, reproduce costs properly, even when an increasing number of complex recipients are treated. Therefore, in this cost determination study, actual costs were calculated and cost drivers identified.
  
  
  
  A standardized microcosting approach allowed for individual cost calculations in 780 lung transplant patients taken care of at Hannover Medical School and University of Munich from 2009 to 2013. A generalized linear model facilitated the determination of characteristics predictive for inpatient costs.
  
  
  
  Lung transplantation costs varied substantially by major diagnosis, with a mean of €85,946 (median €52,938 ± 3,081). Length of stay and ventilation time properly reproduced costs in many cases. However, complications requiring prolonged ventilation or reinterventions were identified as additional significant cost drivers, responsible for high costs.
  
  
  
  Diagnosis Related Groups properly reproduce actual lung transplantation costs in straightforward cases, but costs in complex cases may remain underestimated. Improved grouping should consider major diagnosis, a higher gradation of ventilation time, and the number of reinterventions to allow for more reasonable reimbursement.
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Munich, Germany; Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Vogl
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery.
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Department for Thoracic Surgery, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hatz
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hunger
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Munich, Germany; Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.affiliation: Center for Public Health and Healthcare, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Heidrun
authors.initials: H
authors.lastname: Lingner
authors.affiliation: Department of Internal Medicine V, Ludwig-Maximilians-Universität Muenchen and Asklepios Fachkliniken Muenchen-Gauting, Munich, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Behr
authors.affiliation: Department for Thoracic Surgery, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Winter
authors.affiliation: Departments of Cardiac Surgery.
authors.forename: Rene
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Anesthesiology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zwissler
authors.affiliation: Departments of Cardiac Surgery.
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.affiliation: Department for Thoracic Surgery, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Strobl
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Jaeger
authors.affiliation: Department for Thoracic Surgery, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany. Electronic address: gerhard.preissler@med.uni-muenchen.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Preissler
mesh_terms: D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation
keywords: DRG; costs; economic evaluation; lung transplantation; resource utilization