Higher Costs and Lower Reimbursement of Endobronchial Valve Therapy vs Lung Volume Reduction Surgery in the United States.

Abstract

Recent data suggest that lung volume reduction surgery (LVRS) may proffer superior outcomes compared with endobronchial valves (EBVs) for the treatment of advanced emphysema. Nevertheless, following federal approval in 2018, the application of EBVs has grown exponentially. We sought to compare health care costs and reimbursement for endoscopic and surgical lung volume reduction among Medicare beneficiaries. Using the US Centers for Medicare & Medicaid Services inpatient claims database, we evaluated all beneficiaries with severe emphysema either undergoing LVRS or receiving EBVs (January 2018-December 2023). Diagnosis-related group and International Classification of Diseases, Tenth Revision procedure codes were used to define all variables and comorbidities including a validated metric of frailty. Doubly robust risk adjustment was performed with inverse probability weighting and multilevel regression models to assess longitudinal costs, charges, readmission rates, and reimbursement. Of the 7009 patients (LVRS, n = 4405; EBV, n = 2604), EBV recipients had lower comorbidity scores (Elixhauser 3.33 vs 3.89; P < .001), shorter length of stay (7 vs 9 days; P < .0001), but higher index hospitalization costs ($22,312 vs $20,679; P = .003), lower Medicare reimbursement ($24,710 vs $27,714; P < .0001), and higher 1-year reintervention rates (13.7% vs 1.36%; P < .001). After risk adjustment, EBVs remained associated with higher index and longitudinal costs (P < .001). Medicare beneficiaries receiving EBVs have higher procedure-related costs, lower reimbursement, and increased longitudinal health care costs compared with patients undergoing LVRS. Considering recent data highlighting superior outcomes with LVRS, these results further underscore the need to revisit multidisciplinary decision-making about the role of surgery in the management of advanced emphysema.