Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema

Scott D. Ramsey, Kristin Berry, Ruth Etzioni, Robert M. Kaplan, Sean D. Sullivan, Douglas E. Wood

Research output: Contribution to journalArticle

193 Citations (Scopus)

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 per quality-adjusted life-year gained at 3 years and $53,000 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 per quality-adjusted life-year gained at 3 years and $21,000 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.

Original languageEnglish (US)
Pages (from-to)2092-2102
Number of pages11
JournalNew England Journal of Medicine
Volume348
Issue number21
DOIs
StatePublished - May 22 2003
Externally publishedYes

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Pneumonectomy
Emphysema
Cost-Benefit Analysis
Quality-Adjusted Life Years
Therapeutics
Uncertainty
Rehabilitation
Lung
Mortality
Medicare
Health Care Costs
Randomized Controlled Trials
Economics
Quality of Life
Exercise
Costs and Cost Analysis
Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ramsey, S. D., Berry, K., Etzioni, R., Kaplan, R. M., Sullivan, S. D., & Wood, D. E. (2003). Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. New England Journal of Medicine, 348(21), 2092-2102. https://doi.org/10.1056/NEJMsa030448

Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. / Ramsey, Scott D.; Berry, Kristin; Etzioni, Ruth; Kaplan, Robert M.; Sullivan, Sean D.; Wood, Douglas E.

In: New England Journal of Medicine, Vol. 348, No. 21, 22.05.2003, p. 2092-2102.

Research output: Contribution to journalArticle

Ramsey, SD, Berry, K, Etzioni, R, Kaplan, RM, Sullivan, SD & Wood, DE 2003, 'Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema', New England Journal of Medicine, vol. 348, no. 21, pp. 2092-2102. https://doi.org/10.1056/NEJMsa030448
Ramsey, Scott D. ; Berry, Kristin ; Etzioni, Ruth ; Kaplan, Robert M. ; Sullivan, Sean D. ; Wood, Douglas E. / Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. In: New England Journal of Medicine. 2003 ; Vol. 348, No. 21. pp. 2092-2102.
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