BlueCross BlueShield of Tennessee Medical Policy Manual

Endobronchial Valves

DESCRIPTION

Endobronchial valves are synthetic devices deployed into ventilatory airways of the lung to control airflow. They have been investigated for use in individuals who have prolonged broncho-pleural air leaks, as well as an alternative to lung volume reduction surgery (LVRS) in individuals with lobar hyperinflation from severe emphysema.

Endobronchial valves permit one-way air movement. During inhalation the valve is closed preventing air flow to the diseased area of the lung. The valve opens during exhalation to allow air to escape from the diseased area of the lung. When used to treat persistent air leak from the lung into the pleural space, the endobronchial valve theoretically permits less air flow across the diseased portion of the lung during inhalation aiding in air leak closure. The valve may be placed, and subsequently removed, by bronchoscopy.

Endobronchial valves have also been investigated for use in severe emphysematous COPD when peripheral lung tissue forms bullae. The diseased portions of the lung ventilate poorly, cause air trapping, and hyperinflate, compressing relatively normal lung tissue. They also may rupture, causing a pneumothorax. Use of an endobronchial valve is thought to prevent hyperinflation of these bullae.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

The only available data on endobronchial valves for treating air leaks are uncontrolled trials with small numbers of heterogeneous individuals. Data on the FDA-approved endobronchial valve device are particularly limited. For individuals with advanced or severe emphysema, the evidence is insufficient that the technology improves the net health outcome.

SOURCES 

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2017). Bronchial valves (7.01.128). Retrieved June 29, 2017 from BlueWeb. (12 articles and/or guidelines reviewed)

British Thoracic Society. (November, 2011). British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Retrieved August 14, 2015 from the National Guideline Clearinghouse (NGC: 9126).

Davey, C., Zoumot, Z., Jordan, S., McNulty, W., Carr, D., Hind, M., et al. (2015). Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomized controlled trial. Lancet, 386 (9998), 1066-1073. (Level 2 evidence)

Fiorelli, A., D’Andrilli, A., Anile, M., Diso, D., Poggi, C., Polverino, M., et al. (2016). Sequential bilateral bronchoscopic lung volume reduction with one-way valves for heterogeneous emphysema. Annals of Thoracic Surgery, 102 (1), 287-294. Abstract retrieved July 22, 2016 from PubMed database.

Gkegkes, I., Mourtarakos, S., & Gakidis, I. (2015). Endobronchial valves in treatment of persistent air leaks: a systematic review of clinical evidence. Medical Science Monitor, 21, 432-438. (Level 2 evidence)

Klooster, K., ten Hacken, N. H., Hartman, J. E., Kerstjens, H. A., van Rikxoort, E. M, & Slebos,D. J. (2015). Endobronchial valves for emphysema without interlobar collateral ventilation. New England Journal of Medicine, 373 (24), 2325-2335. Abstract retrieved July 22, 2016 from PubMed database.

Liu, H., Xu, M., Xie, Y., Gao, J., & Ni, S. (2015). Efficacy and safety of endobronchial valves for advanced emphysema: a meta analysis. Journal of Thoracic Disease, 7 (3), 320-328. (Level 1 evidence)

National Institute for Health and Care Excellence. (2013, March). Insertion of endobronchial valves for persistent air leaks.  Retrieved August 14, 2015 from www.nice.org.uk/accreditation.

National Institute for Health and Care Excellence. (2013, September). Insertion of endobronchial valves for lung volume reduction in emphysema.  Retrieved August 14, 2015 fromwww.nice.org.uk/accreditation.

Thomsen, C., Theilig, D., Herzog, D., Poellinger, A., Doellinger, F., Schreiter, N., et al. (2016). Lung perfusion and emphysema distribution affect the outcome of endobronchial valve therapy. International Journal of Chronic Obstructive Pulmonary Disease, 2016; 11: 1245-1259. (Level 4 evidence)

U.S. Food and Drug Administration. (2008, October). Center for Devices and Radiological Health. Listing of CDRH humanitarian device exemptions. H060002. Retrieved August 17, 2015 fromhttp://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/hdeapprovals/ucm161827.htm.

Winifred. S. Hayes, Inc. Medical Technology Directory. (2015, February; last update search February 2016). Bronchoscopic lung volume reduction for chronic obstructive pulmonary disease). Retrieved July 22, 2016 from www.Hayesinc.com/subscribers. (184 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  4/24/2011

MOST RECENT REVIEW DATE:  8/10/2017

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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