Cost-Effectiveness of VATS Versus Open Thoracotomy for Primary Spontaneous Pneumothorax

Chang, Woon Ha; Oh, Tae Yun; Kim, Mee Hea; Choe, Joo Won

Abstract

BACKGROUND: Recently, video-assisted thoracoscopic surgery(VATS) has been accepted as the standard treatment for spontaneous pneumothorax. However, comparatively high recurrent rate and cost-effectiveness are still controversial. The recurrent rate after bullectomy with VATS is reported to be as high as 5-10% whereas it is below 2% in thoracotomy. There is no statistical report on cost-effectiveness in Korean health care system. Material and METHOD: Our retrospective analysis was performed on 173 cases of surgically treated primary spontaneous pneumothorax at Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, from January 1997 to July 1999. There were 104 cases VATS and 69 cases of thoracotomy. We analysed the operative indication, gender, operating time, amounts of the staples used, tube drainage, tube stay time, postoperative complications, recurrent rate, operation room cost, and total cost. RESULT: Operation time was 71.3 +/-29.5minutes in VATS group and 141 +/-52minutes in thoracotomy group(P<0.05). The postoperative tube stay and hospital stay are 3.93days and 7.5days in VATS group and 7.0 days and 13.4days in thoracotomy group, respectively(P<0.05, P<0.05). The number of recurrence after the operation in VATS group(6/104, 5.6%) was significantly higher than in thoracotomy group (1/69, 1.4%; P<0.05). The operation room cost was significantly higher in VATS group than in thoracotomy group (won 1,202,192 +/-178,992, won 1,005,669 +/-311,531; P<0.05), but considering the total cost, there was no significant difference between the two groups( won 1,946,110 +/- 487,440, won 1,793,912 +/-308,079; P=0.18).
CONCLUSION
Although operative procedure and discharge policy may affect the recurrent rate and cost, there was no benefit of cost-effectiveness in VATS group and recurrent rate was higher in VATS group than in throacotomy group. It would be helpful to set up a prospective trial comparing cost and results of VATS versus minithoracotomy.