A scoping review of the effectiveness, appropriateness and economic efficiency of the vacuum bell for pectus excavatum within the Swiss healthcare system.

Background
Pectus excavatum (PE) is the most common congenital deformity of the anterior chest wall, with treatment options ranging from physiotherapy and vacuum bell therapy (VBT) to surgical procedures such as the minimally invasive repair of PE (MIRPE). In Switzerland, only surgery is covered by the health insurance, creating access barriers for patients who may benefit from VBT. This review aims to assess the effectiveness, appropriateness, and economic efficiency of VBT and its potential role within the Swiss healthcare system.
Methods
A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Literature was identified through searches in PubMed, Embase, Scopus, MEDLINE, and the Cochrane Library (2005-2024). Twenty-seven studies encompassing 2,271 patients were included based on relevance to the effectiveness, appropriateness, or cost-efficiency of VBT.
Results
VBT appears to be a safe, effective, and cost-efficient alternative to MIRPE, particularly for younger patients with mild to moderate PE. Although high-quality randomized trials are lacking, the reviewed evidence supports VBT as a viable first-line option. Additionally, significant cost differences favor VBT, and its inclusion in reimbursement policies could enhance accessibility and reduce surgical burden.
Conclusions
VBT offers clinically meaningful outcomes at substantially lower cost compared to MIRPE. Incorporating VBT into the Swiss reimbursement system could improve patient access, reduce health system expenditure, and reserve surgery for cases where conservative treatment is insufficient. However, these findings are based on the Swiss healthcare context and may not be directly generalizable to countries with different reimbursement frameworks.