Cost minimization analysis by Monte Carlo simulation in spontaneous versus mechanical ventilation thoracoscopic surgery

Abstract

Background
Spontaneous ventilation video-assisted thoracic surgery (SV-VATS) represents an additional step ahead within the evolution of minimally invasive thoracic surgery and has been shown to be associated with reduced morbidity and hospitalization times in selected cohorts. Nevertheless, the economic implications of this strategy are still under-investigated.
Aim of this study was to perform a cost-minimization analysis in order to compare SV- versus mechanical ventilation (MV) VATS across different surgical scenarios. Costs computation included non-device-related costs and costs related to management of post-operative complications.


Results

We compared SV-VATS (group A) versus MV-VATS (group B) through a cost-minimization analysis. Costs included in the analysis were hourly operating room expenses, daily costs for hospitalization, and costs related to post-operative complications. Economic evaluation was made using Monte Carlo simulation modeling. Two different scenarios were investigated: lung volume reduction surgery for emphysema and wedge resection for lung metastasectomy. Input data about operative room time, hospital stay, and morbidity were retrieved from 2 of our previously published comparative studies. In the first scenario about lung volume reduction surgery, group A presented significantly lower estimated mean costs (€6238.9 ± 2430.9 versus €11,874.1 ± 3529.1 for group B,
p
 < 0.001). The analysis of cost distribution revealed that group B was associated with a wider and higher range of costs, suggesting greater financial variability. Evaluation of cost differences distribution showed that group B was associated with higher costs in 90.8% of simulations, with an expected mean cost saving of €5635.2 ± 4309.5 per patient by adopting SV. In the second scenario about wedge resection, group A confirmed lower estimated mean costs (€3199.8 ± 1074.2 versus €4538.7 ± 2405.4 of group B,
p
 < 0.001) and a narrower cost distribution, reflecting a more predictable economic profile. Distribution of cost difference indicated that patients in group B presented higher costs in 65.8% of simulations, with an expected mean cost saving of €1338.9 ± 2629.9 by choosing SV.



Conclusions
SV-VATS was associated with lower overall costs compared to MV-VATS in different clinical scenarios, suggesting a lower in-hospital financial burden. These findings support the role of this strategy not only as clinically advantageous, but also as a cost-minimizing strategy in healthcare resource management.