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Original research
Cost-effectiveness of ambulatory care management of primary spontaneous pneumothorax: an open-label, randomised controlled trial
  1. Ramon Luengo-Fernandez1,
  2. Filipa Landeiro1,
  3. Rob Hallifax2,3,
  4. Najib M Rahman4
  1. 1Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Nuffield Department of Medicine, University of Oxford, Oxford, UK
  4. 4Oxford NIHR Biomedical Research Centre, Oxford, UK, University of Oxford, Oxford, UK
  1. Correspondence to Dr Rob Hallifax, Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; robert.hallifax{at}ndm.ox.ac.uk

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.

  • 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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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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Footnotes

  • Twitter @ramonluengofern, @DrHallifax

  • Contributors RH and NMR: conceived study design, trial management and oversight, patient recruitment and data collection. RL-F and FL: statistical analysis. RL-F: literature search and initial manuscript preparation. RL-F is the guarantor of the data. All authors reviewed and approved the final manuscript.

  • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (PB-PG-0213-30098). RH was funded by a Medical Research Council Clinical Research Training Fellowship (MR/L017091/1). NMR was funded by the NIHR Oxford Biomedical Research Centre. Rocket Medical UK provided the Pleural Vent devices and consumables for the trial. The trial was sponsored by the University of Oxford and managed by the Oxford Respiratory Trials Unit, who also undertook data management. The views expressed are those of the authors and not necessarily those of the National Institute for Health Research or the UK Department of Health and Social Care.

  • Competing interests NMR reports consultancy fees from Rocket Medical, during the conduct of the study, and Lung Therapeutics and grants from BD Biosciences, outside the submitted work. All other authors declare no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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