A Systematic Review of Cost-Effectiveness Between Outpatient and Inpatient Management of Procedural Interventions: Implications for Pleural Procedures
Bibliographic record
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.130 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.015 |
| Bibliometrics | 0.016 | 0.017 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".