Cost reduction in video-assisted thoracoscopic lobectomy

Video-assisted thoracoscopic surgery lobectomy (VATSL) has become a cornerstone of the management of early stage non-small cell lung cancer as well as of other pulmonary diseases. While VATSL is clearly associated with reduced complications and the potential for earlier return to normal activities compared to the traditional open thoracotomy approach, there has been substantial debate over the cost-effectiveness of the procedure. We and others have hypothesized that if one could reduce the costs of VATSL by targeted interventions in the way the operation is carried out, then its cost-effectiveness could be improved—likely to the point at which it would be reproducibly more cost-effective than thoracotomy lobectomy (THORL). In this review, we discuss the recent literature on cost-effectiveness and cost-reduction strategies for VATSL, including our own work on the subject.