Quality of Well-being Outcomes in the National Emphysema Treatment TrialSurvival in National Emphysema Treatment Trial
From the National Institutes of Health (Drs Kaplan and Sun), Bethesda, MD; and the Department of Medicine and the Department of Family and Preventive Medicine (Dr Ries), University of California, San Diego, CA.
アメリカからの報告．
National Emphysema Treatment Trial (NETT)のデータをもちいて，
重症肺気腫患者の治療法による違いを調べた．
１２１８名の重症肺気腫患者をランダムに内科的最大治療，肺容量減少手術（ＬＶＲＳ）
の２群にふりわけた．
Quality of Well-being Scale (QWB)をＱＯＬの指標として用い，
ベースライン，６，１２，２４，３６，４８，６０，７２か月後に調べた．
＜結果＞
ＱＷＢはベースラインでは両群で差がなかった．
両群ともリハビリプログラム後にＱＷＢスコアは改善した．
ＬＶＲＳ群ではＱＷＢスコアは２年目までは改善したが，
内科治療群では時間とともに低下した．
死亡をスコア０とするかどうかに関係なく，ＬＶＲＳ群の方が良好なＱＷＢスコアで
その差は６年間つづいた．
ＬＶＲＳ群では６年にわたり平均0.3のquality-adjusted life years (QALYs)であり，
3.6か月の「よい生活」と同等であった．
＜感想＞
重症の肺気腫では，最大の内科治療をするよりもＬＶＲＳを行った方が
６年にわたりＱＯＬがよかったようです．
ＬＶＲＳの適応をしっかりと判断することで「よい生活」を送ってもらえる
可能性がありそうです．
BACKGROUND: Surgical and medical treatments for emphysema may affect both quality and quantity of life. The purpose of this article is to report outcomes from the National Emphysema Treatment Trial (NETT) using an index that combines quality and quantity of life.
METHODS: This was a prospective randomized clinical trial. Following pulmonary rehabilitation, 1,218 patients with severe emphysema were randomly assigned to maximal medical therapy or to lung volume reduction surgery (LVRS). A generic quality-of-life measure, known as the Quality of Well-being Scale (QWB), was administered at baseline and again at 6, 12, 24, 36, 48, 60, and 72 months following treatment assignment.
RESULTS: At baseline, QWB scores were comparable for the Medical and LVRS groups. For both groups, scores significantly improved following the rehabilitation program. The QWB scores before death for patients in the LVRS group improved up to the year 2 visit, whereas scores for the Medical group dropped significantly following the baseline visit. Imputing zeros (0) for death, QWB scores decreased significantly for both groups. With or without scoring death as 0, the LVRS group achieved better outcomes, and the significant differences were maintained until the sixth year. Over 6 years of follow-up, LVRS produced an average of 0.30 quality-adjusted life years (QALYs), or the equivalent of about 3.6 months of well life.
CONCLUSIONS: Compared with maximal medical therapy alone, patients undergoing maximal medical therapy plus LVRS experienced improved health-related quality of life and gained more QALYs.