title: Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema.
abstract: BACKGROUND
  The National Emphysema Treatment Trial, a randomized clinical trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema, included a prospective economic analysis.
  
  
  METHODS
  After pulmonary rehabilitation, 1218 patients at 17 medical centers were randomly assigned to lung-volume-reduction surgery or continued medical treatment. Costs for the use of medical care, medications, transportation, and time spent receiving treatment were derived from Medicare claims and data from the trial. Cost effectiveness was calculated over the duration of the trial and was estimated for 10 years of follow-up with the use of modeling based on observed trends in survival, cost, and quality of life.
  
  
  RESULTS
  Interim analyses identified a group of patients with excess mortality and little chance of improved functional status after surgery. When these patients were excluded, the cost-effectiveness ratio for lung-volume-reduction surgery as compared with medical therapy was 190,000 dollars per quality-adjusted life-year gained at 3 years and 53,000 dollars per quality-adjusted life-year gained at 10 years. Subgroup analyses identified patients with predominantly upper-lobe emphysema and low exercise capacity after pulmonary rehabilitation who had lower mortality and better functional status than patients who received medical therapy. The cost-effectiveness ratio in this subgroup was 98,000 dollars per quality-adjusted life-year gained at 3 years and 21,000 dollars at 10 years. Bootstrap analysis revealed substantial uncertainty for the subgroup and 10-year estimates.
  
  
  CONCLUSIONS
  Given its cost and benefits over three years of follow-up, lung-volume-reduction surgery is costly relative to medical therapy. Although the predictions are subject to substantial uncertainty, the procedure may be cost effective if benefits can be maintained over time.
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA 98109, USA. sramsey@fhcrc.org
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: Kristin
authors.initials: K
authors.lastname: Berry
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kaplan
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
mesh_terms: D003362:Cost-Benefit Analysis; D004358:Drug Therapy / Q000191:economics; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D011013:Pneumonectomy / Q000191:economics*; D011656:Pulmonary Emphysema / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis