Estimated growth of lung volume reduction surgery among Medicare enrollees: 1994 to 1996.

OBJECTIVE

To estimate the number of lung volume reduction surgery procedures performed on Medicare enrollees from 1994 to 1996.

DESIGN

Statistical analysis of national Medicare claims data.

PATIENTS

All Medicare enrollees with emphysema hating claims records for pulmonary resection procedures from January 1, 1993, through December 31, 1996.

MAIN OUTCOME MEASURE

Estimated number of lung volume reduction procedures performed per month from July 1994 through December 1996.

RESULTS

An estimated 1,212 lung volume reduction procedures were performed on Medicare enrollees between July 1994 and December 1995 (95% confidence interval, 1,012 to 1,408). Nearly one half of these procedures were performed in the last 3 months of 1995. At the time Health Care Financing Administration announced that it would suspend reimbursement for the procedure (December 1995), lung volume reduction surgery was being performed in 37 states. The number of claims per month decreased from a peak of 169 in December 1995, to 11 in March 1996. Average Medicare reimbursement per procedure was $31,398.

CONCLUSIONS

Lung volume reduction surgery for patients increased rapidly following its reintroduction in 1994. The growth of lung volume reduction surgery demonstrates that widespread adoption and utilization of a surgical procedure can occur in the absence of data from controlled clinical trials. Medicare expenditures for lung volume reduction surgery were an estimated $30 million to $50 million. Performing the surgery for all current Medicare patients who meet the appropriate clinical criteria would cost an estimated $1 billion.