Cost-effectiveness of lung volume reduction coil treatment in patients with severe emphysema: results from the 2-year follow-up crossover REVOLENS study (REVOLENS-2 study)

Abstract

Background: The REVOLENS study compared lung volume reduction coil treatment to usual care in patients with severe emphysema at 1 year, resulting in improved quality-adjusted life-year (QALY) and higher costs. Durability of the coil treatment benefit and its cost-effectiveness at 2 years are now assessed.

Methods: After one year, the REVOLENS trial's usual care group patients received coil treatment (second-line coil treatment group). Costs and QALYs were assessed in both arms at 2 years and an incremental cost-effectiveness ratio in cost per QALY gained was calculated. The uncertainty of the results was estimated by probabilistic bootstrapping.

Results: The average cost of coil treatment in both groups was estimated at €24,356. The average total cost at 2 years was €9655 higher in the first-line coil treatment group (p = 0.07) and the difference in QALY between the two groups was 0.127 (p = 0.12) in favor of first-line coil treatment group. The 2-year incremental cost-effectiveness ratio (ICER) was €75,978 / QALY. The scatter plot of the probabilistic bootstrapping had 92% of the replications in the top right-hand quadrant.

Conclusion: First-line coil treatment was more expensive but also more effective than second-line coil treatment at 2 years, with a 2-year ICER of €75,978 / QALY.

Trial registration: ClinicalTrials.gov Identifier NCT01822795 .

Keywords: Coil treatment; Cost-effectiveness; QALY; Severe emphysema.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of Dijon Est I and the French Agency for Medicines and Health Products Health approved the study protocol.

Competing interests

Hervé Mal received honorarium from Boehringer, Bayer, Roche, Astellas, Chiesi, Actellion, Pfizer, Novartis, GSK outside the submitted work; Charles Hugo Marquette has been involved as investigators in previous studies sponsored by BTG/PneumRx, and received travel reimbursements and speaker fees for educational sessions and consulting from BTG/PneumRx; Hervé Dutau received travel reimbursements and speaker fees for educational sessions and consulting from BTG/PneumRx; Arnaud Bourdin received honorarium from Astra Zeneca, GSK, Boehringer, Novartis, Teva, Chiesi, Actellion, Gilead, Roche outside the submitted work; Jean Michel Vergnon received travel reimbursements and speaker fees for educational sessions from BTG/PneumRx; Christophe Pison received honorarium from BTG/PneumRx and his hospital funds to conduct trials from Nuvaira, PulmonX, BTG/PneumRx; Vincent Jounieaux received travel reimbursements and speaker fees for educational sessions and consulting from BTG/PneumRx; Armelle Marceau received honorarium from BTG/PneumRx; Gaëtan Deslée has been involved as investigator in previous studies sponsored by BTG/PneumRx, and received travel reimbursements and speaker fees for educational sessions and consulting from BTG/PneumRx; Sylvie Leroy, Jeanne Marie Perotin, Romain Kessler, Mathieu Salaün, Margaux Bonnaire, Sylvain Dukic, Coralie Barbe, Isabelle Durand-Zaleski indicated no conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Flow chart of the study (CONSORT). a The reasons for not performing bilateral treatment were death before second treatment (n=1), anaphylactic shock at induction of anesthesia for the second coil treatment (n=1) (further analyses demonstrated allergy to penicillin), and pneumonia after the first coil treatment leading to unwillingness of the patient to undergo a second coil treatment (n=1). Two patients with unilateral coil treatment at 3-month follow-up were treated with a contralateral coil treatment at 12 and 18 months post-randomisation. b These two patients were alive at 12 months, but did not come for the planned visit at 12 months, and were considered for subsequent assessment at 24 months. c Bilateral treatment not performed because of pneumothorax (n=1), pneumonia (n=2) or death (n=1). One patient was treated with a contralateral coil treatment at 27 months post first treatment. d One systolic pulmonary artery pressure > 50 mmHg and one anticoagulant therapy which could not be stopped for coil treatment and also active smoking.e 1 patient moved abroad and two patients refused to come back for the follow-up

Fig. 2

Utilities during the 2-years follow-up period for both groups. The total QALYs in each group are represented by the area under the curves and the QALY difference between the 2 groups by the area between the curves

Fig. 3

Scatter plot of incremental cost and effectiveness of first-line coil treatment compared to second-line coil treatment The set of ICERs estimated by the non-parametric bootstrap are presented by the cloud of points on the cost-effectiveness plane.

Fig. 4

Cost-effectiveness acceptability curve showing the probability that first-line coil treatment is cost-effective compared to second-line coil treatment