Quality of Life and Financial Measures in Surgical and Non-Surgical Treatments in Emphysema

  • J. D. Miller
  • F. Altaf
Reference work entry


The cost of health care is continuing to escalate world wide. More people are living longer and often with more challenging medical conditions. The personal and societal cost for survival is growing yearly.

Medical and surgical advances, unfortunately, have not been able to stop this growing financial burden. Occasionally new surgical interventions can favorably affect the overall health care cost. If an intervention can create a healthier patient with fewer health care needs, society may experience an overall saving. Such was the early hope for  Lung Volume Reduction Surgery (LVRS).

If LVRS can save productive lives and reduce a patients’ ongoing need for medicines, such as oxygen therapy, there may be an overall financial gain to society. If, however, LVRS differs costs into the future as well as add the new surgical costs clearly there will be no overall saving. In this later instance the gain to a patients’ well being must be weighed against the cost of the intervention. Lastly when there is no overall gain for the patient and no saving to society it is clear that we should not invest in the intervention.

This chapter reviews the tools used to evaluate a patients health-related quality of life ( HRQOL) and reviews the world literature evaluating health gains and losses following LVRS. The cost of LVRS to society will be reviewed and compared with other medical and surgical interventions with an emphasis on other treatments for advanced  emphysema.

We begin with a general outline of the definition of Quality of Life (QOL), and a review of the research tools in use to evaluate QOL. These tools can be designed to assess a patients’ quality of life specifically as it related to a particular disease state such as chronic obstructive lung disease ( COPD) (a disease specific QOL measure), or it can be designed as a broader tool assessing QOL as ones’ general health impacts on their perception of well being.

The two major short-comings of a QOL measure is its subjective nature (individual preference based) and its inability to include one of the worst health related outcomes, death. Traditionally a subject who has died is not able to report on their QOL and is omitted from further assessment and is not included in the group assessment. Only patients who are able to complete the questionnaire at the give time are included in that time’s overall group score. Health Utilities, however, is a societal preference based score and ascribes the value zero for death. It therefore can be used as a tool to follow a group of patients over time and include loss of life in the overall scoring of health quality for that group.

Healthcare economists can use  health utility (HU) scores of a study group over time as a measure of that groups’ overall health for that time period. It is reported in units called Quality Adjusted Life Years ( QALYs). A comparison between research groups allows the investigator an opportunity to assess the gain or loss of health. This difference is also reported in quality adjusted life years (QALYs). Knowing the gain or loss in QALYs and the cost difference between two groups allows the economist to report the cost per QALY. The cost per QALY is a value of a very general nature and allows for comparison of interventions of various types to one and other.

This chapter will outline in more detail each of these measures and tools and discuss their application to the financial assessment of LVRS.


Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Minimally Important Clinical Difference Pulmonary Rehabilitation Health Utility Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


chronic obstructive pulmonary disease


Chronic Respiratory Disease Questionnaire


cost utility assessment


cost utility index


Carbon monoxide diffusion capacity


forced expiratory volume in one second


health-related quality of life


 health utility index


The incremental cost-utility ratio


inhaled steroid in obstructive lung disease


long-term oxygen therapy


lung volume reduction surgery


minimal important clinical difference


Modified Medical Research Council Dyspnea Index


National Emphysema Treatment Trial


Nottingham Health Profile


peripheral arterial oxygen content


Pulmonary Function Status and Dyspnea Questionnaire


pulmonary function status scale


 pulmonary rehabilitation


quality adjusted life years


quality of life


Quality of Well-Being Questionnaire


Short Form 36 questionnaire


St. George’s Respiratory Questionnaire


sickness impact profile


Seattle Obstructive Lung Disease Questionnaire


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© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • J. D. Miller
  • F. Altaf

There are no affiliations available

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