What type of study is this?

This is a Systematic Review study.

September 10, 2025

A Systematic Review of Cost-Effectiveness Between Outpatient and Inpatient Management of Procedural Interventions: Implications for Pleural Procedures

Key Points

Outpatient pleural procedures offer lower costs and shorter stays compared to inpatient management, especially IPC placement.
Preliminary results show outpatient IPC placement yields reduced hospitalization costs without compromising safety or symptom relief.
Systematic review followed PRISMA guidelines, with thorough searches across multiple databases for eligible studies comparing outpatient and inpatient procedures.
Outcomes focus on direct/indirect costs, length of stay, and quality-adjusted life years, supporting outpatient management as a viable alternative.

Abstract

Background: Pleural procedures such as thoracentesis, indwelling pleural catheter (IPC) placement, and pleurodesis are critical for managing pleural effusions.1-2 Traditionally performed in inpatient settings, these procedures are increasingly being offered in outpatient clinics to reduce hospital stays and costs.3 However, the comparative cost-effectiveness of inpatient versus outpatient pleural procedures remains poorly defined. Methods: A systematic review is being conducted in accordance with PRISMA guidelines. Comprehensive searches were performed in MEDLINE (Ovid), EMBASE, CINAHL and Web of Science from database inception to August 2025. Search strategies combined controlled vocabulary (e.g., Pleural Effusion, Thoracentesis, Catheterization) with keywords including “outpatient,” “ambulatory,” “day care,” “inpatient,” and “cost-effectiveness.” Eligible studies include randomized controlled trials, cohort studies, and economic evaluations directly comparing inpatient versus outpatient pleural procedures. Title and abstract screening were conducted in Covidence, followed by full-text review. Data extraction focuses on study design, setting, sample size, intervention type, outcomes (direct and indirect costs, length of stay, quality-adjusted life years), and reported incremental cost-effectiveness ratios. Results: Preliminary synthesis indicates that outpatient IPC placement is associated with lower direct hospitalization costs and shorter length of stay compared to inpatient pleurodesis, with no compromise in safety or symptom relief. Evidence for thoracentesis and other procedures is emerging but suggests similar cost-saving potential in outpatient settings. Conclusions: Early findings suggest that outpatient pleural procedures, particularly IPC insertion, are promising cost-effective alternatives to traditional inpatient management. A full synthesis of included studies is in progress, and results will be prepared for peer-reviewed publication.

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