Cost-effectiveness of ambulatory care management of primary spontaneous pneumothorax: an open-label, randomised controlled trial.
Thorax
; 77(9): 913-918, 2022 09.
Article
in En
| MEDLINE
| ID: mdl-35354647
ABSTRACT
BACKGROUND:
Ambulatory management of primary spontaneous pneumothorax has been shown to reduce initial hospitalisation, but at the expense of increase adverse events. As a result, questions remain about the cost-effectiveness of this option.OBJECTIVES:
A within-trial economic evaluation alongside a randomised controlled trial was performed to assess the cost-effectiveness of ambulatory care when compared with standard guideline-based management.METHODS:
Patients were randomly assigned to treatment with either an ambulatory device or standard guideline-based management (aspiration, standard chest tube insertion or both). Follow-up was 12 months. Outcomes included healthcare resource use and costs, quality of life, quality-adjusted life-years (QALYs) and cost-effectiveness.RESULTS:
236 patients were recruited and randomly assigned to ambulatory care (n=117) and standard care (n=119). After multiple imputation for missing data, patients in the ambulatory care group had significantly lower National Health Service healthcare costs (-£788, 95% CI difference -1527 to -50; p=0.037) than those in the standard care group. There were no differences in the number of QALYs gained (mean difference -0.001, 95% CI difference -0.032 to 0.030; p=0.95). When standard care was compared with ambulatory care, the incremental cost-effectiveness ratio was £799 066 per QALY gained, well above current thresholds of cost-effectiveness. As a result, the probability of ambulatory care being cost-effective was 0.93.CONCLUSION:
Outpatient ambulatory management is highly likely to be a cost-effective option in the management of primary pneumothorax. TRIAL REGISTRATION NUMBER ISRCTN79151659.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Pneumothorax
Type of study:
Clinical_trials
/
Guideline
/
Health_economic_evaluation
Limits:
Humans
Language:
En
Journal:
Thorax
Year:
2022
Type:
Article
Affiliation country:
United kingdom