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This study compared video-assisted thoracoscopic surgery (VATS) and chest tube drainage in terms of recurrence prevention and cost-effectiveness, incorporating sensitivity analyses to evaluate robustness across variable assumptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a retrospective cohort (2010\u20132020), 245 first-episode PSP patients with computed tomography (CT)-confirmed blebs were included. Propensity score matching (1:1, caliper\u2009=\u20090.02) balanced baseline characteristics (age, bleb size, etc.), generating 33 matched pairs. Primary outcomes were recurrence rate and incremental cost-effectiveness ratio (ICER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      VATS reduced 5-year recurrence rates from 48.5% to 12.1%\n                      <jats:italic>(P<\/jats:italic>\n                      \u2009=\u20090.004; absolute risk reduction [ARR]\u2009=\u200936.4%, number needed to treat [NNT]\u2009=\u20092.75) and improved recurrence-free interval (hazard ratio [HR]\u2009=\u20090.166,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The base-case ICER was \u00a5160,300 per quality-adjusted life-year (QALY) gained (\u00a548,937 per recurrence avoided), with 99.14% probability of cost-effectiveness at China\u2019s World Health Organization (WHO)-recommended willingness-to-pay (WTP) threshold (\u00a5287,247 \/ QALY). Sensitivity analyses confirmed robustness: ICER remained favorable at \u00a5156,338 \/ QALY when pneumothorax utility dropped to 0.5; a 20% cost increase yielded \u00a5192,200 \/ QALY. Discount rate variations (3%: \u00a5159,800 \/ QALY; 6%: \u00a5138,029 \/ QALY) maintained\u2009&gt;\u200998.4% cost-effectiveness probability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>VATS reduces recurrence by 83.4% in first-episode PSP with blebs and demonstrates robust cost-effectiveness. Early surgical intervention should be considered for patients with blebs across diverse resource settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-026-04155-9","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T01:05:39Z","timestamp":1770253539000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and cost-effectiveness of VATS versus chest tube drainage in first-episode primary spontaneous pneumothorax with blebs: a propensity score-matched retrospective study"],"prefix":"10.1186","volume":"26","author":[{"given":"Qingcai","family":"Lin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"issue":"7","key":"4155_CR1","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1016\/S2213-2600(15)00220-9","volume":"3","author":"OJ Bintcliffe","year":"2015","unstructured":"Bintcliffe OJ, Hallifax RJ, Edey A, Feller-Kopman D, Lee YCG, Marquette CH, et al. 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