title: Quality of well-being outcomes in the National Emphysema Treatment Trial.
abstract: BACKGROUND
  Surgical and medical treatments for emphysema may affect both quality and quantity of life. The purpose of this article is to report outcomes from the National Emphysema Treatment Trial (NETT) using an index that combines quality and quantity of life.
  
  
  METHODS
  This was a prospective randomized clinical trial. Following pulmonary rehabilitation, 1,218 patients with severe emphysema were randomly assigned to maximal medical therapy or to lung volume reduction surgery (LVRS). A generic quality-of-life measure, known as the Quality of Well-being Scale (QWB), was administered at baseline and again at 6, 12, 24, 36, 48, 60, and 72 months following treatment assignment.
  
  
  RESULTS
  At baseline, QWB scores were comparable for the Medical and LVRS groups. For both groups, scores significantly improved following the rehabilitation program. The QWB scores before death for patients in the LVRS group improved up to the year 2 visit, whereas scores for the Medical group dropped significantly following the baseline visit. Imputing zeros (0) for death, QWB scores decreased significantly for both groups. With or without scoring death as 0, the LVRS group achieved better outcomes, and the significant differences were maintained until the sixth year. Over 6 years of follow-up, LVRS produced an average of 0.30 quality-adjusted life years (QALYs), or the equivalent of about 3.6 months of well life.
  
  
  CONCLUSIONS
  Compared with maximal medical therapy alone, patients undergoing maximal medical therapy plus LVRS experienced improved health-related quality of life and gained more QALYs.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00000606; URL: www.clinicaltrials.gov.
authors.affiliation: National Institutes of Health, Bethesda, MD; Agency for Healthcare Research and Quality (Rockville, MD). Electronic address: robert.kaplan@ahrq.hhs.gov.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kaplan
authors.affiliation: National Institutes of Health, Bethesda, MD.
authors.forename: Qiankun
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Department of Medicine and the Department of Family and Preventive Medicine, University of California, San Diego, CA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ries
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011013:Pneumonectomy; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000188:drug therapy* / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years