Cost-effectiveness of lung volume reduction surgery

Abstract

Lung volume reduction surgery (LVRS) is a costly procedure that can improve quality and quantity of life. Given the prevalence of emphysema, the costs involved with its management, and resource constraints on all health care delivery systems, evaluating the cost-effectiveness of LVRS is important. In this article, we describe the purposes and principles of cost-effectiveness analysis and how those principles were applied in evaluating LVRS. We present the results of the cost-effectiveness analysis that was conducted alongside the National Emphysema Treatment Trial and other economic studies of LVRS and discuss how these should be interpreted in the context of current reimbursement guidelines.

Figure 1.

Possible outcomes of lung volume reduction surgery (LVRS) versus medical therapy (MT).

Figure 2.

Ten-year cost-effectiveness acceptability curves for lung volume reduction surgery (LVRS) versus medical therapy for all patients and for three subgroups with significantly improved clinical outcomes in the LVRS arm (reduced mortality, improved quality of life, or both). The curve represents the probability that LVRS is associated with a cost per quality-adjusted life-year (QALY) gained that is lower than the corresponding cost-effectiveness ratios displayed on the x axis. The value of the ceiling ratio at a probability of 0.5 is the median cost per QALY for LVRS. Solid horizontal lines denote 95% confidence limits for the projections.