Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema.
Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema.
复制标题
严重肺气肿患者肺减容手术的成本效益。
DOI：
10.1056/nejmsa030448
复制
发表时间：
2003
期刊：
影响因子：
--
通讯作者：
NationalEmphysemaTreatmentTrialResearchGroup
中科院分区：
文献类型：
--
作者：
Ramsey,ScottD;Berry,Kristin;Etzioni,Ruth;Kaplan,RobertM;Sullivan,SeanD;Wood,DouglasE;NationalEmphysemaTreatmentTrialResearchGroup
国家肺气肿治疗试验是一项比较肺减容手术与药物治疗严重肺气肿的随机临床试验，包括一项前瞻性经济分析。方法将17个医学中心的1218例肺功能康复患者随机分为肺减容手术组和继续内科治疗组。使用医疗护理、药物、交通和接受治疗的时间的费用来自医疗保险索赔和试验数据。在试验期间计算成本效益，并使用基于观察到的生存率、成本和生活质量趋势的模型估计10年随访的成本效益。结果中期分析确定了一组患者的死亡率过高，手术后功能状态改善的可能性很小。当排除这些患者时，肺减容手术与药物治疗相比的成本-效果比在3年时为190，000/质量调整生命年，在10年时为53，000/质量调整生命年。亚组分析发现，肺康复治疗后以上叶肺气肿为主且运动能力低的患者，与接受药物治疗的患者相比，死亡率更低，功能状态更好。该亚组的成本-效果比在3年时为每质量调整生命年98，000，在10年时为21，000。Bootstrap分析显示，亚组和10年估计数存在很大的不确定性。结论：考虑到三年随访的成本和效益，肺减容手术相对于药物治疗是昂贵的。尽管预测存在很大的不确定性，但如果能够长期保持效益，则该程序可能具有成本效益。
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 190,000perquality-adjustedlife-yeargainedat3yearsand 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 98,000perquality-adjustedlife-yeargainedat3yearsand 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.