Effects of timing of thoracoscopic surgery for primary spontaneous pneumothorax on prognosis and costs

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 payersʹ 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. $6,556), followed by the second (U.S. $2,988) and the third (U.S. $2,532). 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. $30,564 and U.S. $29,915 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.