Discussion
NSCLC
NSCLC, COMPLICATIONS
Of the two strategies, VATS was found to be more expensive, and it did not result in cost reductions in the post-surgical period at 30 days or at 3 months. Like in other RCTs, we did not show significant benefits for VATS in terms of post-operative complications or mortality [This trial is the first prospective multicentre RCT to assess the medico-economic impact of VATS compared with open thoracotomy for the management of NSCLC in France. To our knowledge, only one other cost-utility study by Bendixen et al. has been published to date comparing the two strategies [The present study has several limitations. Only the hospital perspective was considered insofar as only hospital resources consumed were available based on the data collected in the e-CRF. In this perspective, in order to calculate the production cost per stay as recommended in medico-economic guidelines [Nonetheless, this study has several strengths. This is the first multicentre RCT in France to prospectively evaluate the cost-utility impact of VATS versus open thoracotomy in the management of NSCLC, considering costs from the initial stay and patient follow-up (re-admissions), and utility (QALYs). The centres were required to have performed 50 VATS procedures to be included in the study, thus limiting biases linked to the experience of the surgeons performing VATS. The costing methodology used conforms to the methodological recommendations of health economists [Today, the results of medico-economic studies are considered to be a tool for authorities whose mission is to inform public decision-making on the allocation of health resources (ex: decisions regarding reimbursement). Currently, the procedure of lobectomy or segmentectomy by VATS is valorised through act GFFA009 (