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A Forensic Evaluation of the National Emphysema Treatment Trial Using the Expected Value of Information Approach

Ramsey, Scott D. MD, PhD*†; Blough, David K. PhD*†; Sullivan, Sean D. PhD

doi: 10.1097/MLR.0b013e318160b479
Original Article

Background/Rationale: Expected value of information (EVI) analyses allow researchers to estimate the returns to conducting research. We used EVI techniques to estimate the value of the National Emphysema Treatment Trial (NETT), a multicenter randomized trial of lung–volume-reduction surgery (LVRS) versus medical therapy (MT) for patients with severe emphysema, then compared that result to the trial cost.

Methods: We gathered information on costs and benefits of LVRS and MT before the trial and the costs of conducting the NETT, and compared these data with the results of the cost-effectiveness analysis conducted alongside the trial. We used 2 thresholds to represent the societal value of a quality-adjusted life year (QALY): $50,000 and $100,000.

Results: The cost effectiveness of LVRS versus MT using historical (nontrial) information was $305,000/QALY. Based on these data and the threshold incremental cost-effectiveness ratio values, the expected value of perfect information was US $46 million and $670 million for thresholds $50,000 and $100,000 per QALY, respectively. The NETT was powered for 1250 patients in each arm; ultimately approximately 600 patients in each arm were recruited. With 1250 patients per arm, the expected value of sample information was US $660 million for the threshold of $100,000. The actual cost of the NETT was approximately $60 million. The expected net benefit of sampling was $600 million.

Conclusions: Given the difference between the cost of the trial and the economic benefits of the information, the EVI analyses suggest that federal investment in the NETT trial represented good value for money.

From the *Fred Hutchinson Cancer Research Center; and †Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington.

Supported by the NETT Coordinating Center. The National Emphysema Treatment Trial (NETT) is supported by contracts with the National Heart, Lung, and Blood Institute (N01HR76101, N01HR76102, N01HR76103, N01HR76104, N01HR76105, N01HR76106, N01HR76107, N01HR76108, N01HR76109, N01HR76110, N01HR76111, N01HR76112, N01HR76113, N01HR76114, N01HR76115, N01HR76116, N01HR76118, and N01HR76119), the Centers for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration); and the Agency for Healthcare Research and Quality (AHRQ).

Reprints: Scott D. Ramsey, Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Ave. N, Box 19024, M3-B232, Seattle, WA 98109. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.