Cost-effectiveness of video-assisted thoracic surgery (VATS) versus open thoracic surgery for lung cancer Lopburi Cancer Hospital (LBCH)
Keywords:
Unit cost, Break-even point, VATS, Open thoracotomyAbstract
Background: Currently, VATS is more popular in Thailand due to smaller incisions, less intraoperative blood loss, less postoperative pain, and fewer hospital stays than open thoracotomy. However, VATS requires specialized surgeons, specialized tools, and expensive equipment resulting in higher costs. Objective: To study the costeffectiveness of lung cancer surgery by VATS and Open thoracotomy in LBCH. Methods: The retrospective study by collecting data on 30 patients who underwent lung surgery at LBCH from 1 January 2021 to 30 April 2021, divided into 6 cases of VATS and 24 cases of open thoracotomy, collecting costs of surgery including investment, labor, and equipment costs. Effectiveness data were collected including total medical expenses, operative time, length of hospital stay, and postoperative pain. The unit cost and break-even point were analyzed and the cost-effectiveness of VATS and thoracic surgery were compared. Result: There were 24 open thoracotomy patients, the cost per unit was 47,344.85 baht, the average cost charged from the fund 86,120.13 baht, break-even point 10 times per 4 months, average operation time 75.83 minutes, the average length of hospital stay 10.4 and the average pain score after 3 days of surgery was 3.26 units. There were 6 VATS patients, the cost per unit was 79,775.39 baht, the average cost charged from the fund 63,175.33 baht, break-even point 8.17 times per 4 months, average operation time 53.33 minutes, the average length of hospital stay 8.3 and the average pain score after 3 days of surgery was 1.95 units. In comparison between open thoracic surgery and VATS, the cost-effectiveness ratio of increased length of hospital stay was 14,313.50 baht per 1-day reduction in length of hospital stay. Conclusions: The average cost per case of VATS was higher than open thoracotomy. The unit cost of VATS decreases as the number of patients increases.
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394–424.
Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2017;3(4):524–48.
Imsamran W, Pattatang A, Supaattagorn P, Chiawiriyabunya I, Namthaisong K, Wongsena M, et al. Cancer in Thailand volume IX 2013-2015. Bangkok Thailand: National Cancer Institute Ministry of Public Health; 2018.
Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg 1992;104(6):1679–85.
Shaw JP, Dembitzer FR, Wisnivesky JP, Litle VR, Weiser TS, Yun J, et al. Video-assisted thoracoscopic lobectomy: state of the art and future directions. Ann Thorac Surg 2008;85(2):S705-9.
Marijic P, Walter J, Schneider C, Schwarzkopf L. Cost and survival of video-assisted thoracoscopic lobectomy versus open lobectomy in lung cancer patients: a propensity score-matched study. Eur J Cardiothorac Surg 2020;57(1):92-99.
Triviño A, Congregado M, Loscertales J, Jiménez-Merchán R, Pinos-Vélez N, Cózar F, et al. Experience and development of the video-assisted thoracic surgery lobectomy technique: comparative study with conventional surgery in stage I nonsmall cell lung cancer. Arch Bronconeumol 2014;50(2):57–61.
Rakeid S, Panchan V, Imsamran W, Phakdeeniti S, Chaiwerawattana A. Guidelines for the diagnosis and treatment of lung cancer. Bangkok: Kosit press company limited; 2016.
Al-Ameri M, Bergman P, Franco-Cereceda A, Sartipy U. Video-assisted thoracoscopic versus open thoracotomy lobectomy: a Swedish nationwide cohort study. J Thorac Dis 2018; 10(6):3499-506.
Jawitz OK, Wang Z, Boffa DJ, Detterbeck FC, Blasberg JD, Kim AW. The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies. Eur J Cardiothorac Surg 2017;51(1):169-74.
Nwogu CE, D’Cunha J, Pang H, Gu L, Wang X, Richards WG, et al. VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg 2015;99(2):399-405.
Whitson BA, Andrade RS, Boettcher A, Bardales R, Kratzke RA, Dahlberg PS, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 2007;83(6):1965–70.
Archer L, DeWitt J, Osborne J, Dillon J, Willis B, Wong B. Science aspirations, capital, and family habitus: How families shape children’s engagement and identification with science. American Educational Research Journal 2012;49(5):881-908.
Kneuertz PJ, Singer E, D’Souza DM, Abdel-Rasoul M, Moffatt-Bruce SD, Merritt RE. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: A propensity scoreweighted comparison. J Thorac Cardiovasc Surg 2019; 157(5):2018-26.e2.
Landreneau RJ, Hazelrigg SR, Mack MJ, Dowling RD, Burke D, Gavlick J, et al. Postoperative pain-related morbidity: videoassisted thoracic surgery versus thoracotomy. Ann Thorac Surg 1993;56(6):1285-9.
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