Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis
Thoracoscopic lobectomy has become the preferred approach for surgical management of early stage lung cancer, but the potential higher operative costs limit its widespread use. Theoretically, higher direct costs may be significantly counterbalanced by lower indirect costs, resulting in lower overall...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-03-01
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| Series: | Thoracic Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/1759-7714.13708 |
| _version_ | 1818918175685738496 |
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| author | Alfonso Fiorelli Stefano Forte Francesco Paolo Caronia Francesco Ferrigno Mario Santini René Horsleben Petersen Wentao Fang |
| author_facet | Alfonso Fiorelli Stefano Forte Francesco Paolo Caronia Francesco Ferrigno Mario Santini René Horsleben Petersen Wentao Fang |
| author_sort | Alfonso Fiorelli |
| collection | DOAJ |
| description | Thoracoscopic lobectomy has become the preferred approach for surgical management of early stage lung cancer, but the potential higher operative costs limit its widespread use. Theoretically, higher direct costs may be significantly counterbalanced by lower indirect costs, resulting in lower overall costs for thoracoscopic than for open lobectomy. To support this hypothesis, we reviewed the literature until May 2020, analyzing all papers comparing the cost of thoracoscopic versus open lobectomy.A total of 20 studies provided the most applicable evidence to evaluate this issue. In all the studies apart from one, thoracoscopic lobectomy was associated with higher operative costs due to the increased use of disposable instruments, and prolonged operative time. By contrast, in 17 studies the increased operative costs were significantly offset by indirect costs which were lower in thoracoscopic than in open lobectomy due to fewer postoperative complications, faster recovery, and lower readmission rates. It translated into lower overall costs for thoracoscopic than for open lobectomy in 10 studies, similar costs in seven, and higher in three, despite the lower hospitalization costs. The low bed fees and high prices of disposable instruments in these three studies may explain the discordance. The careful use of disposable instruments, and the minimizing hospitalization costs can reduce the total costs of thoracoscopic lobectomy to levels similar or to below those of open lobectomy. The worry that video‐assisted thoracoscopic surgery lobectomy (VATSL) might be associated with an increased overal cost is thus not warranted, and should not be used as an excuse against the use of VATS in surgery for early stage lung cancers. |
| first_indexed | 2024-12-20T00:45:47Z |
| format | Article |
| id | doaj.art-d8ff7d01792e4a69be711726416425c1 |
| institution | Directory Open Access Journal |
| issn | 1759-7706 1759-7714 |
| language | English |
| last_indexed | 2024-12-20T00:45:47Z |
| publishDate | 2021-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Thoracic Cancer |
| spelling | doaj.art-d8ff7d01792e4a69be711726416425c12022-12-21T19:59:24ZengWileyThoracic Cancer1759-77061759-77142021-03-0112556757910.1111/1759-7714.13708Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysisAlfonso Fiorelli0Stefano Forte1Francesco Paolo Caronia2Francesco Ferrigno3Mario Santini4René Horsleben Petersen5Wentao Fang6Department of Translation Medicine, Thoracic Surgery Unit Università della Campania “Luigi Vanvitelli” Naples ItalyIstituto Oncologico del Mediterraneo (IOM) Catania ItalyThoracic Surgery Unit Ospedale Civico Palermo ItalyPneumology Unit Ospedale Mauro Scarlato Scafati ItalyDepartment of Translation Medicine, Thoracic Surgery Unit Università della Campania “Luigi Vanvitelli” Naples ItalyDepartment of Cardiothoracic Surgery Copenhagen University Hospital Rigshospitalet DenmarkDepartment of Thoracic Surgery Shanghai Chest Hospital, Jiao Tong University Medical School Shanghai ChinaThoracoscopic lobectomy has become the preferred approach for surgical management of early stage lung cancer, but the potential higher operative costs limit its widespread use. Theoretically, higher direct costs may be significantly counterbalanced by lower indirect costs, resulting in lower overall costs for thoracoscopic than for open lobectomy. To support this hypothesis, we reviewed the literature until May 2020, analyzing all papers comparing the cost of thoracoscopic versus open lobectomy.A total of 20 studies provided the most applicable evidence to evaluate this issue. In all the studies apart from one, thoracoscopic lobectomy was associated with higher operative costs due to the increased use of disposable instruments, and prolonged operative time. By contrast, in 17 studies the increased operative costs were significantly offset by indirect costs which were lower in thoracoscopic than in open lobectomy due to fewer postoperative complications, faster recovery, and lower readmission rates. It translated into lower overall costs for thoracoscopic than for open lobectomy in 10 studies, similar costs in seven, and higher in three, despite the lower hospitalization costs. The low bed fees and high prices of disposable instruments in these three studies may explain the discordance. The careful use of disposable instruments, and the minimizing hospitalization costs can reduce the total costs of thoracoscopic lobectomy to levels similar or to below those of open lobectomy. The worry that video‐assisted thoracoscopic surgery lobectomy (VATSL) might be associated with an increased overal cost is thus not warranted, and should not be used as an excuse against the use of VATS in surgery for early stage lung cancers.https://doi.org/10.1111/1759-7714.13708Hospital costslobectomylung cancerthoracoscopythoracotomy |
| spellingShingle | Alfonso Fiorelli Stefano Forte Francesco Paolo Caronia Francesco Ferrigno Mario Santini René Horsleben Petersen Wentao Fang Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis Thoracic Cancer Hospital costs lobectomy lung cancer thoracoscopy thoracotomy |
| title | Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis |
| title_full | Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis |
| title_fullStr | Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis |
| title_full_unstemmed | Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis |
| title_short | Is video‐assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis |
| title_sort | is video assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery results of best evidence topic analysis |
| topic | Hospital costs lobectomy lung cancer thoracoscopy thoracotomy |
| url | https://doi.org/10.1111/1759-7714.13708 |
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