title: Optimal strategy for the first episode of primary spontaneous pneumothorax in young men. A decision analysis.
abstract: OBJECTIVE
  Primary spontaneous pneumothorax (PSP) is not uncommon in young men and is associated with frequent recurrence. The frequent recurrence after conservative treatment and resultant anxiety for recurrence are sources of disability. We explored which procedure is more appropriate as the initial therapy in terms of quality-adjusted life expectancy (QALE).
  
  
  METHODS
  Decision analysis using a Markov model.
  
  
  METHODS
  Structured literature review for clinical probability. Utility derived from patients and medical staff using time trade-off method.
  
  
  METHODS
  Hypothetical cohort.
  
  
  METHODS
  Twenty-year-old men with a first episode of PSP for which simple aspiration was ineffective.
  
  
  METHODS
  One of the following treatment options: 1) thoracoscopic surgery, 2) pleural drainage followed by thoracoscopic surgery for recurrence, 3) pleural drainage followed by thoracoscopic surgery for the second recurrence, 4) pleurodesis followed by thoracoscopic surgery for recurrence, 5) pleurodesis followed by thoracoscopic surgery for the second recurrence, 6) pleural drainage followed by pleurodesis for the first recurrence and thoracoscopic surgery for the second recurrence.
  
  
  RESULTS
  During the 1-year period after one of the initial treatments, the QALE was 9.49 months for thoracoscopic surgery, 9.47 for pleurodesis, and 7.80-7.99 for pleural drainage. The QALE for thoracoscopic surgery was the longest among the 6 strategies during the period from 5 to 24 months. None of the variables in sensitivity analyses altered the main results except for thoracoscopic surgical death rate. When it exceeds 0.3%, pleurodesis becomes the preferred strategy.
  
  
  CONCLUSIONS
  On the basis of the current best available data and patients' preference, thoracoscopic surgery can be considered the treatment of choice for the first episode of PSP.
authors.affiliation: Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koyama
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Noguchi
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008390:Markov Chains; D018700:Pleurodesis / Q000401:mortality*; D011030:Pneumothorax / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D015203:Reproducibility of Results; D013396:Suction / Q000401:mortality*; D020775:Thoracic Surgery, Video-Assisted / Q000401:mortality*; D016896:Treatment Outcome