Comparison of Cost Effectiveness between Video-Assisted Thoracoscopic Surgery (VATS) and Open Lobectomy: A Retrospective Study

Abstract Background Lung cancer is highly prevalent in Chinese population. The association of operative approach with economic burden in these patients remains unknown. ObjectivesThis institution-level cohort study aimed to compare the cost-related clinical outcomes and health care costs among patients undergoing video-assisted thoracoscopic surgery (VATS) and open lobectomy, and to investigate the factors associated with the costs. MethodsThis retrospective cohort study included patients who underwent VATS or open lobectomy in a provincial referral cancer center in China in 2018. Clinical effectiveness measures included post-operative blood transfusion, lung infection, and length of stay (LOS). Hospitalization costs were extracted from hospital information system to assess economic burden. ResultsCompared to open lobectomy group, the VATS lobectomy group had a lower blood transfusion rate (1.70% vs. 4.33%, P=0.033), lower lung infection rate (23.77% vs. 40.87%, P<0.001) and shorter post-operative LOS (9.42 ± 3.72 days vs. 10.97 ± 5.81 days, P<0.001). Total hospitalization costs of VATS lobectomy group and open lobectomy were similar: RMB 84,908.72±18,914.87, RMB 81,944.70 ±16,625.20, respectively. VATS approach, lung infection, longer post-operative length of stay, male sex, lung cancer diagnosis, and heart disease were associated with higher total hospitalization costs (P<0.05). ConclusionsVATS lobectomy has a lower post-operative blood transfusion rate, lower lung infection rate, and shorter post-operative LOS than open lobectomy. Future studies are needed to investigate other aspects of clinical effectiveness and the economic burden from a societal perspective.