title: Video-assisted thoracic surgery versus pleural drainage in the management of the first episode of primary spontaneous pneumothorax.
abstract: BACKGROUND
  The aim of the study was to analyze the cost-effectiveness outcomes of video-assisted thoracic surgery (VATS) in the treatment of primary spontaneous pneumothorax (PSP), comparing the minimally invasive procedure with pleural drainage (PD).
  
  
  METHODS
  Between July 2006 and October 2012, we treated 122 patients with a first episode of PSP by VATS (61 patients) or pleural drainage (61 patients). We established the relationship between costs and quality-adjusted life (QAL) for both techniques.
  
  
  RESULTS
  The total cost per patient of minimally invasive procedure was more advantageous than that of chest tube (€2,422.96 vs €4,855.12). The QAL expectancy of VATS was longer than that of PD (57.00 vs 40.80 at 60 months). The QAL year of VATS (.32 at 1st year and .25 at 5th year) was better than that of PD. Incremental cost-effectiveness ratio of VATS versus PD was between €7,600.00 (1st year) and €10,045.00 (5th year), remaining well below the threshold of acceptability.
  
  
  CONCLUSIONS
  VATS as the first-line treatment for PSP allowed low morbidity, short hospitalization, and excellent quality of life.
authors.affiliation: Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy. Electronic address: duilio.divisi@aslteramo.it.
authors.forename: Duilio
authors.initials: D
authors.lastname: Divisi
authors.affiliation: Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Di Leonardo
authors.affiliation: Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Crisci
mesh_terms: D003362:Cost-Benefit Analysis; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000191:economics / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics; D055815:Young Adult
keywords: Pleural drainage; Primary spontaneous pneumothorax; Quality-adjusted life; Video-assisted thoracic surgery