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Eur J Cardiothorac Surg. 2019 Jun 3. pii: ezz157. doi: 10.1093/ejcts/ezz157. [Epub ahead of print]

Cost and survival of video-assisted thoracoscopic lobectomy versus open lobectomy in lung cancer patients: a propensity score-matched study.

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Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universitaät München, Munich, Germany.
Institute of Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Munich, Germany.
Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
Department of Thoracic Surgery, Ludwig-Maximilians-Universität München, Munich, Germany.



A video-assisted thoracoscopic surgery (VATS) is an accepted alternative to open thoracotomy (OT) in lung cancer patients undergoing lobectomy, but evidence of the benefits of VATS remains inconsistent. The aim of this study was to compare VATS and OT regarding survival, costs and length of hospital stay (LOS).


We identified lung cancer patients (incident 2013) undergoing VATS or OT from German insurance claims data and performed 1:2 propensity score matching. A 3-year survival was analysed using the Kaplan-Meier curves and a univariable Cox model. Group differences in the 3-year lung cancer-related costs and costs of hospital stay with lobectomy were compared via univariable generalized linear gamma models. LOS was compared using the Mann-Whitney-Wilcoxon test.


After propensity score matching, we compared 294 patients undergoing VATS and 588 receiving OT. We found no differences in the 3-year survival (VATS: 73.8%, OT: 69.2%, P = 0.131) or costs for hospital stay with lobectomy (VATS: €11 921, OT: €12 281, P = 0.573). However, VATS patients had significantly lower lung cancer-related costs (VATS: €20 828, OT: €23 723, P = 0.028) and median postoperative LOS (VATS: 9 days, OT: 11 days, P < 0.001).


From a payer's perspective, extending the use of VATS is beneficial, as it shows economic benefits without affecting survival. However, for a more comprehensive assessment of the benefits of VATS from a society's point of view, further aspects such as patient-reported outcomes and provider-related standby costs need to be investigated further.


Length of stay; Lung cancer; Mortality; Open thoracotomy; Spending; Video-assisted thoracic surgery


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