Objectives: To compare the hospital costs associated with powered and manual staplers used in lobectomy for lung cancer through video assisted thoracic surgery (VATS) in a Chinese tier III hospital. Methods: This retrospective cohort study included patients who received VATS lobectomy using powered stapler (POWERED Echelon Flex TM ENDOPATH ® ) and manual stapler (Echelon Flex TM ENDOPATH ® ) manufactured by the same company from January 2016 to December 2018 in a Chinese tier III hospital. The included patients were stratified by the stapler type for the comparisons of total hospital costs and classified hospital costs using Wilcoxon rank sum test. Additionally, multivariate generalized linear regression models were conducted to develop the prediction models for classified hospital costs using patient characteristics, stapler type, utilization of stapler, and unit price of stapler. The developed hospital costs prediction models were used to estimate the hospital costs associated with another popular manual stapler (VICTOR MEDICAL) in the same study cohort. Results: This study included 296 patients using powered stapler and 92 patients using manual stapler for VATS lobectomy for hospital costs comparisons, which identified significant differences in total hospital costs (median U64,322 vs. U67,298, p,0.001) and classified hospital costs for drugs (median U10,161 vs. U13,592, p,0.001) and surgery (median U8,257 vs. U 7,683, p,0.001). Based on the developed hospital costs prediction models and the unit price of another brand manual stapler (VICTOR MEDICAL), using ECHELON powered stapler were associated with U400 lower hospital costs for stapler, U2,948 lower for drugs, U1,003 lower for laboratory tests, and U4,411 lower for total hospital costs than the VICTOR MEDICAL manual stapler in the same study cohort. Conclusions: Using powered stapler of ECHELON for VATS lobectomy could be associated with lower total hospital costs than the manual staplers mainly used in a Chinese tertiary care hospital after full adjustment of confounding effects.

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