WITHDRAWN: Cost-effectiveness of video-assisted thoracoscopic surgery compared to open lobectomy in patients with early-stage lung cancer: Findings from the VIOLET randomised controlled trial

Objectives Lung cancer is the leading cause of cancer death, and has the highest economic burden across Europe of all cancers. Early-stage disease is predominantly treated with surgery, and lung cancer resection using a video-assisted thoracoscopic surgery (VATS) approach has increased, despite limited randomised evidence of its effectiveness and cost-effectiveness compared to open lobectomy. The VIOLET randomised controlled trial compared VATS lobectomy with open surgery in participants with known or suspected (cT1-3, N0-1, M0) lung cancer recruited from nine UK centres. We report the trial cost-effectiveness analysis. Methods A within-trial cost-effectiveness analysis of VATS versus open lobectomy was conducted, with a one year time horizon, from a UK National Health Service and personal social services perspective. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Results Mean QALYs to one year were 0.841 and 0.780 in the VATS and open groups respectively, (a statistically significant mean difference (MD) of +0.060, 95% CI +0.029, +0.092). Total costs of care were £10,879 and £13,581 in the VATS and open groups, (MD= -£2,702, 95% CI –£5,632, +£228). Differences in costs and QALYs favoured VATS, and when combined, resulted in VATS being clearly cost-effective. The probability that VATS is cost-effective at a willingness-to-pay threshold of £20,000 per QALY is >0.99, indeed VATS is considered cost-effective at any threshold, with negligible uncertainty around this finding. Conclusions VATS lobectomy provides good value for money. When considered alongside the published clinical findings from VIOLET that multiple outcomes were significantly improved with VATS, the policy implications are clear: VATS should be the first choice for suitable patients with early-stage lung cancer. ISRCTN13472721