Evidence, economics, and emphysema: Medicare's long journey with lung volume reduction surgery

Use of lung volume reduction surgery (LVRS) increased in the mid-1990s as a palliative therapy for severe emphysema. Rapid growth in procedure volume despite little evidence supporting its safety and effectiveness prompted the Centers for Medicare and Medicaid Services (CMS) to suspend payments and cosponsor a nationwide randomized controlled trial to evaluate the procedure. In this paper we describe the trial and its influence on the CMS's recent coverage decision for LVRS. We describe the implications of this study for evidence-based evaluation of surgical procedures and Medicare's potential role in evaluating experimental treatments that affect its beneficiaries.