ArticleBMC pulmonary medicine2026
Efficacy and cost-effectiveness of VATS versus chest tube drainage in first-episode primary spontaneous pneumothorax with blebs: a propensity score-matched retrospective study.
Article in BMC pulmonary medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOptimal management for first-episode primary spontaneous pneumothorax (PSP) with pulmonary blebs remains uncertain, balancing recurrence prevention against procedural costs. This study compared video-assisted thoracoscopic surgery (VATS) and chest tube drainage in terms of recurrence prevention and cost-effectiveness, incorporating sensitivity analyses to evaluate robustness across variable assumptions.
methodsIn a retrospective cohort (2010-2020), 245 first-episode PSP patients with computed tomography (CT)-confirmed blebs were included. Propensity score matching (1:1, caliper = 0.02) balanced baseline characteristics (age, bleb size, etc.), generating 33 matched pairs. Primary outcomes were recurrence rate and incremental cost-effectiveness ratio (ICER).
resultsVATS reduced 5-year recurrence rates from 48.5% to 12.1% (P = 0.004; absolute risk reduction [ARR] = 36.4%, number needed to treat [NNT] = 2.75) and improved recurrence-free interval (hazard ratio [HR] = 0.166, P < 0.001). The base-case ICER was ¥160,300 per quality-adjusted life-year (QALY) gained (¥48,937 per recurrence avoided), with 99.14% probability of cost-effectiveness at China's World Health Organization (WHO)-recommended willingness-to-pay (WTP) threshold (¥287,247 / QALY). Sensitivity analyses confirmed robustness: ICER remained favorable at ¥156,338 / QALY when pneumothorax utility dropped to 0.5; a 20% cost increase yielded ¥192,200 / QALY. Discount rate variations (3%: ¥159,800 / QALY; 6%: ¥138,029 / QALY) maintained > 98.4% cost-effectiveness probability.
conclusionsVATS reduces recurrence by 83.4% in first-episode PSP with blebs and demonstrates robust cost-effectiveness. Early surgical intervention should be considered for patients with blebs across diverse resource settings.
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