Comparison of costs for video-assisted thoracic surgery lobectomy and open lobectomy for non-small cell lung cancer.
BACKGROUND
To promote the broad use of video-assisted thoracic surgery (VATS) for lobectomy (VATSL) in the management of lung cancer, it should be proved cost-effective, especially in the current cost-sensitive climate. This study evaluated and compared the costs of VATSL and open lobectomy (OL) and analyzed how the surgeon's experience level with VATSL affected the cost.


METHODS
In this study, 86 patients in a VATSL group and 97 patients in an OL group underwent surgery for lung cancer. Cost comparisons were performed for the VATSL and OL groups between patients who had no complications and patients with and without complications according to tumor location and the learning period of the surgeon.


RESULTS
Postoperative complications occurred for 56 patients (30.6%) (14 VATSL vs 42 OL patients; p < 0.05). Patients who underwent VATSL had significant reductions in both chest tube duration (5.4 vs 9.1 days; p = 0.000) and length of hospital stay (7.1 vs 12.0 days; p = 0.000). The mean operation time for VATSL was not significantly longer than for OL (145.8 vs 136.4 min; p = 0.782). The total hospital cost (i.e., that paid by the patient and national insurance combined) was lower for VATSL than for OL according to comparisons both among all patients ($5,391 vs $5,593, respectively) and among only noncomplicated patients ($4,684 vs $4,769, respectively). In terms of tumor location, the total hospital cost for the VATSL group was lower than for the OL group when the surgery was performed on the right lower lobe (RLL), left upper lobe (LUL), and left lower lobe (LLL). The costs were not significantly different between the two learning periods of the surgeons, except for the cost of anesthesia.


CONCLUSIONS
In Korea, VATSL for lung cancer had lower complication rates, shorter hospital stays, and lower total hospital costs than OL.
Cho
Sukki
S
Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Korea.
Do
Young Woo
YW
Lee
Eung Bae
EB
D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000191:economics; D000768:Anesthesia, General / Q000191:economics; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D059032:Learning Curve; D008175:Lung Neoplasms / Q000191:economics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D011013:Pneumonectomy / Q000191:economics* / Q000193:education / Q000379:methods; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011214:Practice, Psychological; D011300:Preoperative Care / Q000191:economics; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics* / Q000193:education; D013908:Thoracotomy / Q000191:economics* / Q000193:education / Q000379:methods