Management of the second episode of spontaneous pneumothorax: a decision analysis Pierre-Emmanuel Falcoz, MD, Christine Binquet, MD, François Clement,

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Management of the second episode of spontaneous pneumothorax: a decision analysis Pierre-Emmanuel Falcoz, MD, Christine Binquet, MD, François Clement, MD, Djamel Kaili, MD, Catherine Quantin, MD, PhD, Sidney Chocron, MD, PhD, Joseph-Philippe Etievent, MD The Annals of Thoracic Surgery Volume 76, Issue 6, Pages 1843-1848 (December 2003) DOI: 10.1016/S0003-4975(03)01324-9

Fig 1 Decision trees representing the choice of management strategies for the second episode of spontaneous pneumothorax. The two clinical strategies to be chosen from are represented at the square decision node of the first tree (A). The probabilities and estimates of their values are listed in Table 1. □ = the choice between strategies (decision node); ○ = the occurrence of chance events (chance node); and ◁ = a logic check in the simulation (terminal node). (CM = conservative management; VATS = video-assisted thoracic surgery.) The Annals of Thoracic Surgery 2003 76, 1843-1848DOI: (10.1016/S0003-4975(03)01324-9)

Fig 2 One-way sensitivity analysis demonstrating the effect of different variables in terms of effectiveness and cost. The upper graphs illustrate the effect of definitive resolution after VATS (A) and after CM (B) on expected effectiveness. The lower graphs illustrate the effect of length of stay for VATS (C) and for CM (2 d) on expected cost (D). The threshold value at which strategies were equivalent was 4.9 days. ■ = CM; ○ = VATS. (CM = conservative management; T = threshold value; VATS = video-assisted thoracic surgery.) The Annals of Thoracic Surgery 2003 76, 1843-1848DOI: (10.1016/S0003-4975(03)01324-9)

Fig 3 Two-way sensitivity analysis of the relation between the length of stay for VATS and CM that illustrates how the optimal strategy changes according to the length of stay when all other probabilities are maintained at the baseline. The black area indicates VATS as the preferred strategy; the white area indicates CM as the preferred strategy. The base-case scenario, indicated by a star, is defined by a mean length of stay of 5.4 days for VATS and 9.4 days for CM. (CM = conservative management; VATS = video-assisted thoracic surgery.) The Annals of Thoracic Surgery 2003 76, 1843-1848DOI: (10.1016/S0003-4975(03)01324-9)