Video-assisted thoracic surgery lobectomy: can we afford it?

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Health Economics

Background:

• Video-assisted thoracoscopic (VATS) lobectomy offers clinical benefits but raises concerns about cost and operative time.
• Assessing the economic sustainability of VATS lobectomy programs is crucial for widespread adoption.

Purpose of the Study:

• To compare the direct medical costs of VATS lobectomy versus open thoracotomy for pulmonary lobectomy.
• To evaluate the overall economic sustainability of implementing a VATS lobectomy program.

Main Methods:

• A retrospective analysis of 346 patients undergoing pulmonary lobectomy (93 VATS, 253 thoracotomy) between 2004-2006.
• Direct medical costs, including disposables, theatre time, high dependency unit (HDU) stay, and hospital stay, were stratified by lobectomy type.

Main Results:

• VATS lobectomy incurred higher mean theatre costs (2533 euro) compared to thoracotomy (1280 euro).
• However, VATS resulted in lower mean HDU costs (1713 euro vs. 2571 euro) and hospital stay costs (3776 euro vs. 4325 euro).
• Overall, VATS lobectomy was less expensive (8023 euro) than open lobectomy (8178 euro), with no significant cost difference for bilobectomy.

Conclusions:

• VATS lobectomy is economically favorable compared to conventional open lobectomy.
• Shorter hospital and HDU stays offset increased operative theatre expenses.
• Reduced resource utilization in VATS frees up beds for other patients, enhancing healthcare system efficiency.