Presented at the 21st annual meeting of the Society for Medical Decision Making, Reno, Nevada, October 5, 1999.
Optimal Strategy for the First Episode of Primary Spontaneous Pneumothorax in Young Men
A Decision Analysis†
Version of Record online: 12 MAR 2002
Journal of General Internal Medicine
Volume 17, Issue 3, pages 193–202, March 2002
How to Cite
Morimoto, T., Fukui, T., Koyama, H., Yoshinori Noguchi and Shimbo, T. (2002), Optimal Strategy for the First Episode of Primary Spontaneous Pneumothorax in Young Men. Journal of General Internal Medicine, 17: 193–202. doi: 10.1046/j.1525-1497.2002.10636.x
- Issue online: 12 MAR 2002
- Version of Record online: 12 MAR 2002
- decision theory;
- quality-adjusted life years;
- video-assisted thoracoscopic surgery
OBJECTIVE: Primary spontaneous pneumothorax (PSP) is not uncommon in young men and is associated with frequent recurrence. The frequent recurrence after conservative treatment and resultant anxiety for recurrence are sources of disability. We explored which procedure is more appropriate as the initial therapy in terms of quality-adjusted life expectancy (QALE).
DESIGN: Decision analysis using a Markov model.
DATA SOURCES: Structured literature review for clinical probability. Utility derived from patients and medical staff using time trade-off method.
SETTING: Hypothetical cohort.
PATIENTS: Twenty-year-old men with a first episode of PSP for which simple aspiration was ineffective.
INTERVENTIONS: One of the following treatment options: 1) thoracoscopic surgery, 2) pleural drainage followed by thoracoscopic surgery for recurrence, 3) pleural drainage followed by thoracoscopic surgery for the second recurrence, 4) pleurodesis followed by thoracoscopic surgery for recurrence, 5) pleurodesis followed by thoracoscopic surgery for the second recurrence, 6) pleural drainage followed by pleurodesis for the first recurrence and thoracoscopic surgery for the second recurrence.
MEASUREMENTS AND MAIN RESULTS: During the 1-year period after one of the initial treatments, the QALE was 9.49 months for thoracoscopic surgery, 9.47 for pleurodesis, and 7.80–7.99 for pleural drainage. The QALE for thoracoscopic surgery was the longest among the 6 strategies during the period from 5 to 24 months. None of the variables in sensitivity analyses altered the main results except for thoracoscopic surgical death rate. When it exceeds 0.3%, pleurodesis becomes the preferred strategy.
CONCLUSION: On the basis of the current best available data and patients' preference, thoracoscopic surgery can be considered the treatment of choice for the first episode of PSP.