C Co os st t--e ef ff fe ec ct ti iv ve en ne es ss s o of f v vi id de eo o--a as ss si is st te ed d t th ho or ra ac co os sc co op pi ic c s su ur rg ge er ry y v ve er rs su us sc co on ns se er rv va at ti iv ve e t tr re ea at tm me en nt t f fo or r f fi ir rs st t t ti im me e o or r r re ec cu ur rr re en nt t s sp po on nt ta an ne eo ou us s p pn ne eu um mo ot th ho or ra ax x Patients in both periods had comparable clinical characteristics. Irrespective of first time or recurrent spontaneous pneumothorax at presentation, drainage and hospitalization times were longer, and complication and recurrence rates were higher in Period 1. When costs due to the waiting time before VATS were excluded, the total costs in Period 1 were higher than in Period 2.Video-assisted thoracoscopic surgery is more effective in treating patients with first time or recurrent spontaneous pneumothorax, with less morbidity and total costs compared to conservative therapy. In view of cost-effectiveness, we feel that a different management of first time or recurrent spontaneous pneumothorax is not justified.

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