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Editorials |

Getting What We Pay For

Don Liss, MD
Author and Funding Information

Affiliations: King of Prussia, PA ,  Dr. Liss is Mid-Atlantic Regional Medical Director, Aetna.

Correspondence to: Don Liss, MD, Mid-Atlantic Regional Medical Director, Aetna, 2201 Renaissance Blvd, Mail Stop F608, King of Prussia, PA 19406; e-mail: lissd@aetna.com



Chest. 2007;131(2):338-339. doi:10.1378/chest.06-2612
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The advent of airway stenting and related interventional bronchoscopic procedures has undoubtedly improved the lives of our patients, particularly improving the palliative care of patients with advanced lung cancer.13 In this issue of CHEST (see page 579), Ernst and colleagues4 review the indications for airway stenting, discuss variations in stent design and materials that bear on the clinical use of these devices, describe the procedural techniques used to place stents, and then review the payments Medicare makes to the interventional pulmonologist and facility for placing an airway stent. The improvement in care resulting from these interventions comes at a financial cost. In the absence of these relatively new advances, disease would simply progress according to its natural history. As is evident from the clinical management algorithms Ernst and colleagues present, these bronchoscopic interventions rarely replace other services; they are additive to the traditional care of patients with central airway obstruction. The net gain in quality and duration of survival achieved for the net increase in costs, the marginal cost-effectiveness, should inform discussion about the value these advances bring relative to other medical interventions. Unfortunately, the evidence necessary to establish the marginal cost-effectiveness of these interventions simply is not yet available.

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