COST-EFFECTIVENESS OF VIDEO-ASSISTED THORACOSCOPIC SURGERY VERSUS CONSERVATIVE TREATMENT FOR FIRST TIME OR RECURRENT SPONTANEOUS PNEUMOTHORAX

The aim of this study was to analyse differences in efficacy and costs in treating first time or recurrent spontaneous pneumothorax by conse rvative therapy (pleural drainage or observation) and video-assisted t horacoscopic surgery (VATS). Retrospectively, 112 patients treated by conservative therapy during 1985-1989 (Period 1) were compared with 97 patients treated by VATS during 1991-1994 (Period 2), Mean follow-up time in each period was more than 2 yrs. Patients in both periods had comparable clinical characteristics. Irrespective of first time or rec urrent spontaneous pneumothorax at presentation, drainage and hospital ization times were longer, and complication and recurrence rates were higher in Period 1. When costs due to the waiting time before VATS wer e excluded, the total costs in Period 1 were higher than in Period 2. Video-assisted thoracoscopic surgery is more effective in treating pat ients with first time or recurrent spontaneous pneumothorax, with less morbidity and total costs compared to conservative therapy. In view o f cost-effectiveness, we feel that a different management of first tim e or recurrent spontaneous pneumothorax is not justified.