title: Effects of timing of thoracoscopic surgery for primary spontaneous pneumothorax on prognosis and costs.
abstract: BACKGROUND
  Primary spontaneous pneumothorax recurs frequently. Timing of video-assisted thoracoscopic surgery to prevent recurrence is controversial and long-term costs remain inconclusive.
  
  
  METHODS
  We constructed a Markov model to assess the effect of different timings for surgery on health status, costs, and cost effectiveness from the payers' perspective in Japan.
  
  
  RESULTS
  During 1-year follow-up, the proportions of patients who underwent surgery after the first and second drainage were 46% and 36%, respectively. Average 1-year cost for surgery at the first episode was highest (U.S. dollars 6556), followed by the second (U.S. dollars 2988) and the third (U.S. dollars 2532). Incremental cost for surgery at the first episode compared with the second and that at the second episode compared with the third were U.S. dollars 30564 and U.S. dollars 29915 per quality-adjusted life year, respectively. Sensitivity analyses showed utility and length of hospital stay for surgery have the strongest effect on incremental cost.
  
  
  CONCLUSIONS
  Thoracoscopic surgery at the first episode significantly increased costs, but could be acceptable from a cost-effectiveness perspective.
authors.affiliation: Department of General Medicine and Clinical Epidemiology, Kyoto University Hospital and Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Noguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koyama
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishiwaki
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004322:Drainage / Q000191:economics; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008390:Markov Chains; D011030:Pneumothorax / Q000191:economics* / Q000601:surgery*; D011379:Prognosis; D011788:Quality of Life; D012008:Recurrence; D012680:Sensitivity and Specificity; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics*; D013997:Time Factors