No attempt has been made to estimate the aggregate annual health care expenditures associated with lung transplantation in the U.S.

The data required for this analysis were abstracted from previously published reports. Additional analyses were performed to compute actual and inflation-adjusted annual aggregate charges for 1988 through 2011. Charges were imputed for 1988 through 1992 based on 1993 data, the first year for which national charge data for lung transplantation were available. The modern era of lung transplantation began in 1983.

The average billed charge for a lung transplant in 1993 was $197,700. This figure included hospital charges, physician fees, and organ procurement costs. Based on actuarial analyses, and adjusted for inflation, this figure decreased in 1996 and 1999, but has steadily increased since 2002.

As shown, since 2002, the actual average billed per procedure charge exceeds the expected average charge, given inflation. There is no obvious explanation for the observed variation between actual and expected charges, other than inflated hospital markups intended to address substantial third party payer discounts, which are typically based on a percentage of billed charges. For example, one major insurer promotes its so-called “centers of excellence network” by claiming that “clients save an average of 51 percent per transplant episode.”

National estimates of health care expenditures reflect billed charges, not actual reimbursement. This is misleading but, if the same logic is applied to lung transplantation, insurers were billed $1.2 billion for lung transplants in 2011, compared with $402.8 million in 1995, the year after Medicare began paying for lung transplantation and $11.9 million in 1988.

Third party reimbursement for lung transplantation is increasingly adverse. To compensate, hospitals have increased their charges. Thus, in constant dollars, total health care expenditures associated with lung transplantation in the U.S are increasing disproportionately relative to inflation.

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