title: Vats Versus Axillary Minithoracotomy in the Management of the Second Episode of Spontaneous Pneumothorax: Cost-Benefit Analysis.
abstract: Video-assisted thoracic surgery (VATS) was considered the gold standard approach in recurrent spontaneous pneumothorax, with unanimous consensus of opinions. The cost-effectiveness analysis in the surgical treatment of recurrence of primary spontaneous pneumothorax (PSP) was carried out comparing VATS with muscle-sparing axillary minithoracotomy (MSAM).
  
  
  
  Between July 2006 and October 2012 we treated 56 patients with a second episode of PSP by VATS or open approach. Time of intervention, prolonged air leaks, duration of pleural drainage, length of hospitalization, and long-term morbidity were evaluated, establishing the relationship between costs and quality-adjusted life for each technique.
  
  
  
  The assessment of pain and threshold of tenderness was more favorable in VATS in respect to MSAM during the 5 years of follow-up (p = 0.004 and <0.001 at 1st year; p = 0.006 and <0.002 at 5th year). The minimally invasive method was less expensive than axillary minithoracotomy (2443.44 € vs. 3170.80 €). The quality-adjusted life expectancy of VATS was better than that of MSAM (57.00 vs. 49.2 at 60 months) as well as the quality-adjusted life year (0.03 at 1st year and 0.13 at 5th year). Incremental cost per life year gained of VATS versus MSAM was between 24,245.33 € (1st year) and 5776.31 € (5th year), making it advantageous at 3rd, 4th, and 5th years.
  
  
  
  VATS compared to MSAM in the treatment of a second episode of PSP ensured undoubted clinical advantages associated with significant cost savings.
authors.affiliation: Department of Thoracic Surgery, "G. Mazzini" Hospital, University of L'Aquila, Piazza Italia 1, Teramo, Italy. duilio.divisi@aslteramo.it.
authors.forename: Duilio
authors.initials: D
authors.lastname: Divisi
authors.affiliation: Department of Thoracic Surgery, "G. Mazzini" Hospital, University of L'Aquila, Piazza Italia 1, Teramo, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Di Leonardo
authors.affiliation: Department of Thoracic Surgery, "G. Mazzini" Hospital, University of L'Aquila, Piazza Italia 1, Teramo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Crisci
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004865:Equipment and Supplies, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D061646:Operative Time; D010147:Pain Measurement; D017288:Pain Threshold; D011030:Pneumothorax / Q000191:economics / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics*; D013908:Thoracotomy / Q000191:economics* / Q000379:methods; D055815:Young Adult