Study: Lung reduction surgery helps some emphysema sufferers

Sunday, June 1, 2003

June 2, 2003

WASHINGTON - Encouraging results from a recent study on lung-reduction surgery for people with emphysema should spur Medicare to pay for some of the procedures, say industry watchers.

Results from the trial appeared in the May 22 issue of the New England Journal of Medicine.

The trial, conducted at 17 research centers around the country, enrolled 1,218 patients with severe emphysema. All the participants received six to 10 weeks of pulmonary rehabilitation, including counseling, medication, exercise training and other techniques to help them understand and manage their condition.

Half the patients were then randomly selected to undergo surgery, while the other half received conventional medical therapy. In May 2001, the group monitoring the study identified a subgroup of participants who had a high risk of dying from the procedure. The protocol was revised to exclude such patients from surgery.

Among the 84% who survived the surgery, about a quarter had a significantly improved quality of life and lived longer, Dr. Zab Mosenifar of Cedars-Sinai Medical Center in Los Angeles, who participated in the study, told The New York Times. These patients had most of their disease concentrated in the upper lobes of the lungs and had a low initial tolerance for exercise. Medicare will almost certainly approve coverage for these patients, he said.

An additional 40% had an improved quality of life, but did not survive longer. Medicare will have a tough time deciding on these patients, Mosenifar said.

The operation, which costs about $35,000, involves cutting away diseased portions of the lungs. Typically doctors take out about one-quarter to one-third of their total lung tissue, hoping to help the good parts of the lung work more freely and efficiently by removing the damaged bulk around them.

Doctors familiar with or involved in the study estimated only 5% to 10% of people with emphysema are suitable for the operation, according to the Los Angeles Times. The study will help doctors decide who is right for the operation.

Dr. Sean Tunis, chief medical officer for CMS, estimated that a few thousand of the lung operations are performed each year. Medicare will probably decide on coverage in 30 to 90 days and would probably decide in favor of the operation, he told The New York Times.

Emphysema is irreversible and contributes to 100,000 deaths annually in the United States. Prior to this study, little clear proof existed that lung reduction surgery actually improved a person’s life.