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Cost‐effectiveness of endobronchial valve treatment in patients with severe emphysema compared to standard medical care
Author(s) -
Hartman Jorine E.,
Klooster Karin,
Groen Henk,
ten Hacken Nick H.T.,
Slebos DirkJan
Publication year - 2018
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13295
Subject(s) - medicine , quality adjusted life year , cost effectiveness , quality of life (healthcare) , cost effectiveness analysis , randomized controlled trial , surgery , risk analysis (engineering) , nursing
ABSTRACT Background and objective Bronchoscopic lung volume reduction using endobronchial valves (EBV) is an effective new treatment option for severe emphysema patients without interlobar collateral ventilation. The objective of this study was to perform an economic evaluation including the costs and cost‐effectiveness of EBV treatment compared with standard medical care (SoC) from the hospital perspective in the short term and long term. Methods For the short‐term evaluation, incremental cost‐effectiveness ratios (ICER) were calculated based on the 6‐month end point data from the STELVIO randomized trial. For the long‐term evaluation, a Markov simulation model was constructed based on STELVIO and literature. The clinical outcome data were quality‐adjusted life‐years (QALY) based on the EuroQol5‐Dimensions (EQ5D) questionnaire, the 6‐min walking distance (6MWD) and the St George’s Respiratory Questionnaire (SGRQ). Results The mean difference between the EBV group and controls was €16 721/patient. In the short‐term (6 months), costs per additional QALY was €205 129, the ICER for 6MWD was €160 and for SGRQ was €1241. In the long term, the resulting cost‐effectiveness ratios indicate additional costs of €39 000 per QALY gained with a 5‐year time horizon and €21 500 per QALY gained at 10 years. In comparison, historical costs per additional QALY 1 year after the coil treatment are €738 400, 5 years after lung volume reduction surgery are €48 415 and 15 years after double‐lung transplantation are €29 410. Conclusion The positive clinical effects of EBV treatment are associated with increased costs compared with SoC. Our results suggest that the EBV treatment has a favourable cost‐effectiveness profile, also when compared with other treatment modalities for this patient group.