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Original Research: COPD |

Quality of Well-being Outcomes in the National Emphysema Treatment TrialSurvival in National Emphysema Treatment Trial

Robert M. Kaplan, PhD; Qiankun Sun, PhD; Andrew L. Ries, MD, MPH, FCCP
Author and Funding Information

From the National Institutes of Health (Drs Kaplan and Sun), Bethesda, MD; and the Department of Medicine and the Department of Family and Preventive Medicine (Dr Ries), University of California, San Diego, CA.

CORRESPONDENCE TO: Robert M. Kaplan, PhD, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850; e-mail: robert.kaplan@ahrq.hhs.gov


Dr Kaplan is currently at the Agency for Healthcare Research and Quality (Rockville, MD).

FUNDING/SUPPORT: This study was supported by contracts with the National Heart, Lung, and Blood Institute [Grants N01HR76101, N01HR76102, N01HR76103, N01HR76104, N01HR76105, N01HR76106, N01HR76107, N01HR76108, N01HR76109, N01HR76110, N01HR76111, N01HR76112, N01HR76113, N01HR76114, N01HR76115, N01HR76116, N01HR76118, and N01-HR76119], the Center for Medicare and Medicaid Services (formerly the Health Care Financing Administration), and the Agency for Healthcare Research and Quality.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):377-387. doi:10.1378/chest.14-0528
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BACKGROUND:  Surgical and medical treatments for emphysema may affect both quality and quantity of life. The purpose of this article is to report outcomes from the National Emphysema Treatment Trial (NETT) using an index that combines quality and quantity of life.

METHODS:  This was a prospective randomized clinical trial. Following pulmonary rehabilitation, 1,218 patients with severe emphysema were randomly assigned to maximal medical therapy or to lung volume reduction surgery (LVRS). A generic quality-of-life measure, known as the Quality of Well-being Scale (QWB), was administered at baseline and again at 6, 12, 24, 36, 48, 60, and 72 months following treatment assignment.

RESULTS:  At baseline, QWB scores were comparable for the Medical and LVRS groups. For both groups, scores significantly improved following the rehabilitation program. The QWB scores before death for patients in the LVRS group improved up to the year 2 visit, whereas scores for the Medical group dropped significantly following the baseline visit. Imputing zeros (0) for death, QWB scores decreased significantly for both groups. With or without scoring death as 0, the LVRS group achieved better outcomes, and the significant differences were maintained until the sixth year. Over 6 years of follow-up, LVRS produced an average of 0.30 quality-adjusted life years (QALYs), or the equivalent of about 3.6 months of well life.

CONCLUSIONS:  Compared with maximal medical therapy alone, patients undergoing maximal medical therapy plus LVRS experienced improved health-related quality of life and gained more QALYs.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT00000606; URL: www.clinicaltrials.gov

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