The Cost-effectiveness Analysis of Video-assisted Thoracoscopic Surgery (VATS) on First Recurrent Primary Spontaneous Pneumothorax

• Main Authors: Chia-Chun Chu, 朱家駿
• Other Authors: 馬作鏹
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/69501161178879044785

碩士 === 中國醫藥大學 === 醫務管理學研究所碩士班 === 97 === Primary spontaneous pneumothorax often occurs on tall and slim healthy young men. Although the morality of patients after receiving the traditional treatment is low, the chances of recurrence can be as high as 20-60%, thus posing a great threat to the quality of life and even the lives of the patients. Suggested treatments of primary spontaneous pneumothorax vary from country to country. The chances of reoccurrence and the consumption of medical resources differ by using different methods of treatment. Under the current health care system of Taiwan, most first time primary spontaneous pneumothorax patients are treated by the method of chest drains while surgery is used for patients with recurrence. The video-assisted thoracoscopic surgery is one of the methods of treatments for primary spontaneous pneumothorax patients. This method is able to effectively reduce the days of hospitalization, the chances of recurrence and postoperative pain of the patients. However, the medical costs of implementation of this method are relatively high. In the circumstances of limited health care resources, it is in fact an important issue for clinical care and medical management personnel to choose the medical service of cost-effectiveness from different treatment methods for a single disease. This study compared the application of video-assisted thoracoscopic surgery in cases of first recurrent primary spontaneous pneumothorax patients with the traditional chest drains treatment in terms of cost-effectiveness, and discussed the risk factors of the recurrence of pneumothorax. Medical records and National Health Insurance data of patients of first recurrent primary spontaneous pneumothorax treated during 1986-2007 by the case hospital were selected to be compared with the matching group in terms of cost and effectiveness. Factors lead to the differences of the two groups were further discussed. In comparison to the chest drains cases, the implementation of video-assisted thoracoscopic surgery can reduce hospitalization time by 2.3 days and reduce medical costs in a total of NT$3,018. However, the National Health Insurance payment of operation and anesthesia increases by about NT$45,898, leading to the final incremental cost of about NT$49,319. The incremental effectiveness of the video-assisted thoracoscopic surgery is reducing the recurrence by about 21.23%. Thus, it costs about NT$ 2091 to reduce recurrence rate by 1%. The treatment costs for recurrence in the future can be converted into the present day medical costs of NT$14,382. Compared with the first recurrence of pneumothorax, the incremental costs of NT$49319 for the video-assisted thoracoscopic surgery is relatively lower. Factors affecting the recurrence of pneumothorax include: sex, side of pneumothorax disease, smoking status, method of treatment, and the size of pneumothorax. Chi-Square test found that only smoking status and method of treatment were statistically significant with the Chi-Square values at 4.2777 (p=0.0386) and 13.6674 (p=0.0002) respectively. Meanwhile the continuous variables include: age, height, body weight and body mass index. After converting the variables into categorical variables by quartation, the Chi-Square test indicated that only body mass index was statistically significant with its Chi-Square value at 10.2350 (p=0.0167) . Regarding primary spontaneous pneumothorax patients of first time recurrence, the affecting risk factors for recurrence include the habit of smoking, using only the traditional chest drains method and the low body mass index. The treatment of video-assisted thoracoscopic surgery in comparison to the chest drains treatment is not cost-effective as the assessment of research results suggests.