Updated evaluation of the cost-effectiveness of lung volume reduction surgery.
BACKGROUND
The National Emphysema Treatment Trial, a randomized clinical trial of lung volume reduction surgery (LVRS) vs medical therapy for severe emphysema, included a prospective economic analysis. We present an updated analysis of cost-effectiveness with 1-year additional follow-up data.


METHODS
Following pulmonary rehabilitation, 1,218 patients at 17 medical centers were randomized to receive LVRS or continued medical treatment. The cost-effectiveness of LVRS vs medical therapy was calculated over the duration of the trial (January 1998 to December 2003) and estimated at 10 years using modeling based on observed trends in survival, cost, and quality of life.


RESULTS
The cost-effectiveness of LVRS vs medical therapy was $140,000 per quality-adjusted life-year (QALY) gained (95% confidence interval, $40,155 to $239,359) at 5 years, and was projected to be $54,000 per QALY gained at 10 years. In subgroup analysis, the cost-effectiveness of LVRS in patients with upper-lobe emphysema and low exercise capacity was $77,000 per QALY gained at 5 years, and was projected to be $48,000 per QALY at 10 years. Compared to the initial results, the updated results are similar for the overall cohort but vary substantially for the subgroups.


CONCLUSIONS
LVRS is costly relative to other health-care programs during the time horizon when costs and outcomes are known. The extended follow-up period offers more certainty regarding the long-term value and economic impact of this procedure.
Ramsey
Scott D
SD
Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA. Electronic address: sramsey@fhcrc.org.
Shroyer
A Laurie
AL
Department of Medicine, University of Colorado, Denver, CO.
Sullivan
Sean D
SD
Departments of Pharmacy, University of Washington, Seattle, WA.
Wood
Douglas E
DE
Surgery, University of Washington, Seattle, WA.
D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000191:economics*; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000191:economics / Q000401:mortality / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D015996:Survival Rate