Endobronchial Valves for the Management of Severe Emphysema

What Is the Issue? People with severe emphysema who do not experience relief with non-invasive therapies such as medication, physical activity, and smoking cessation may need advanced treatments. Endobronchial valves are an alternative therapy that may improve exercise capacity and quality of life, and are less invasive compared to lung reduction surgery or transplants. What Did We Do? A 2019 CADTH report summarized clinical effectiveness evidence for valves compared to standard care. CADTH sought to update this evidence with new clinical research and include information on cost-effectiveness, which was not part of the previous report. A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on emphysema and endobronchial valves. The search was limited to English-language documents published since 2018. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We did not find systematic reviews or health technology assessments published since 2018 that contained clinical evidence not already captured in the 2019 CADTH report. Two RCTs provide updated clinical evidence for endobronchial valves compared to standard care, and 1 RCT contains evidence on valves compared to lung surgery. The evidence suggests that valves may improve lung function, breathing ability, and physical activity in middle-aged and older adults with emphysema compared to standard care; the effect on quality of life and safety is unclear. The previous CADTH report showed lung function, breathing ability, physical activity, and quality of life were favourable for valve treatment compared to standard care. The previous CADTH report showed that valves resulted in harmful outcomes compared to standard care; however, in the current review, safety was difficult to assess due to poor reporting. When comparing valves to lung surgery, lung surgery may improve quality of life compared to valves; other outcomes did not favour one therapy over another. For cost-effectiveness, valves may be favourable compared to standard medical care, while their cost-effectiveness compared to lung volume reduction surgery is unclear. One study was conducted in Canada, and no studies were conducted in children and younger adults. What Does it Mean? Endobronchial valves are a potential therapy for people with severe emphysema with some favourable clinical and cost outcomes, but the evidence for their safety is unclear. Decision-makers may wish to consider the balance of favourable and harmful effects in existing evidence before more high-quality evidence in Canada, especially for safety, is available.