TABLE 2.

PROJECTED AND OBSERVED COST-EFFECTIVENESS RATIOS FOR LUNG VOLUME REDUCTION SURGERY VERSUS MAXIMAL MEDICAL THERAPY AT OBSERVED AND PROJECTED YEARS OF FOLLOW-UP FROM RANDOMIZATION, USING OBSERVATIONS UP TO 3 AND 5 YEARS POSTRANDOMIZATION

		Incremental Cost Effectiveness Ratio† for Subgroups Defined by:
Time Period	All Patients*	Upper-Lobe Emphysema, Low Exercise Capacity†	Upper-Lobe Emphysema, High Exercise Capacity†	Non–Upper-Lobe Emphysema, Low Exercise Capacity†
Observed up to 3 yr	$190,000	$98,000	$236,500	$326,000
Observed up to 5 yr	$140,000	$77,000	$170,000	$225,000
Projected at 10 yr based on 3 yr of follow-up‡	$58,000	$21,000	$54,000	Dominated§
Projected at 10 yr based on 5 yr of follow-up‡	$54,000	$48,000	$40,000	$87,000

^*Results exclude 140 patients previously found to be at high risk for death, 3 patients who were not enrolled in Medicare, 8 patients who were enrolled in Medicare+Choice plans, and 1 patient who was missing claims records. Lung volume reduction surgery was not cost-effective for patients in the subgroup with non–upper-lobe predominant emphysema and high exercise capacity who had higher costs and reduced quality-adjusted life-years (QALYs) compared with the medical group.

^†Costs and QALYs after Year 1 are discounted at 3% per annum.

^‡See text for description of the method of projecting costs and QALYs.

^§Patients undergoing lung volume reduction surgery in the subgroup with non–upper-lobe predominant emphysema and low exercise capacity had higher total costs and fewer QALYs compared with patients in the medical group.