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Original research
Cost-effectiveness of ambulatory care management of primary spontaneous pneumothorax: an open-label, randomised controlled trial


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.

  • health economist

Data availability statement

Data are available upon reasonable request. All data requests should be submitted to the chief Investigator (NMR) for consideration. Access to anonymised data may be granted for non-commercial research at the discretion of NMR.

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