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Ann Thorac Surg 2003;76:1843-1848
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

Management of the second episode of spontaneous pneumothorax: a decision analysis

Pierre-Emmanuel Falcoz, MDa*, Christine Binquet, MDb, François Clement, MDa, Djamel Kaili, MDa, Catherine Quantin, MD, PhDb, Sidney Chocron, MD, PhDa, Joseph-Philippe Etievent, MDa

a Department of Thoracic and Cardiovascular Surgery, Jean-Minjoz Hospital, Besançon, France
b Department of Biostatistics, University Hospital, Dijon, France

Accepted for publication June 3, 2003.

* Address reprint requests to Dr Falcoz, Department of Thoracic and Cardiovascular Surgery, Hôpital Jean-Minjoz, Boulevard Fleming, 25000 Besançon, France
e-mail: pierre-emmanuel.falcoz{at}wanadoo.fr

BACKGROUND: Optimal management for patients presenting a second episode of spontaneous pneumothorax remains controversial. The aim of this study was to compare two possible treatment strategies, video-assisted thoracic surgery (VATS) and conservative management, in order to assess which of the two was better adapted for the treatment of the second episode of spontaneous pneumothorax.

METHODS: The authors propose a decision analytic model including a cost-effectiveness study to compare two clinical strategies: VATS (reference strategy) and conservative management (alternative strategy). Data were obtained from a Medline search for English language articles and cost estimates were derived from the financial and public health departments of our hospital. The model was analyzed to determine the baseline strategy leading to the highest expected effectiveness and the lowest expected cost.

RESULTS: Conservative management offered a slight advantage in expected effectiveness value (99.99 vs 99.93 for VATS). VATS produced the lowest expected cost (€4347 vs €7536 for conservative management). The incremental cost-effectiveness ratio was €57,750. Within the ranges tested, the sensitivity analysis presented consistent results in terms of effectiveness and advocated conservative management as the best strategy. In terms of cost, with the exception of length of stay, the sensitivity analysis was insensitive in estimating the different probabilities, and favored VATS over conservative management.

CONCLUSIONS: In the management of the second episode of spontaneous pneumothorax, VATS offers substantial savings in cost for only a slight decrease in effectiveness, when compared with conservative management.




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J-M. Tschopp, R. Rami-Porta, M. Noppen, and P. Astoul
Management of spontaneous pneumothorax: state of the art.
Eur. Respir. J., September 1, 2006; 28(3): 637 - 650.
[Abstract] [Full Text] [PDF]


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