Optimal strategy for the first episode of primary spontaneous pneumothorax in young men. A decision analysis

Journal of General Internal Medicine
Takeshi MorimotoTakuro Shimbo

Abstract

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). Decision analysis using a Markov model. Structured literature review for clinical probability. Utility derived from patients and medical staff using time trade-off method. Hypothetical cohort. Twenty-year-old men with a first episode of PSP for which simple aspiration was ineffective. 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. During the 1-year period after one of the initial treatments, the QALE was 9.49 months for thoracoscopic surgery, 9.47 for pleur...Continue Reading

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