Vacuum bell device for people with pectus excavatum

SHTG Council considerations

1. The Council acknowledged that the evidence base is limited, consisting mainly of retrospective studies which are more prone to bias. The Council agreed that, on balance, the body of evidence was sufficient to demonstrate that the VB device was likely to provide positive treatment outcomes in a selected group of patients, with few safety concerns.
2. The Council noted that the VB device is mainly offered to people with a mild PE as a conservative treatment option, when they would not normally be eligible for surgery and have no other treatment options. The VB device also has the potential to treat people with more moderate and severe PEs to reduce the need for surgery. The Council recognised the patient and service benefits from fewer surgeries.
3. A topic expert from the Scottish National Chest Wall Service described the patient pathway for people with a chest wall difference in NHSScotland. The first VB device was prescribed in NHSScotland in 2018, and since then nearly 400 have been fitted. The expert noted that most patients are aged between 5 and 16 years (median age 13). The service in Scotland includes physiotherapists, surgeons and psychologists. Consultations are provided remotely when feasible.
4. Following discussion with the topic expert, the Council noted that treatment with the VB device requires considerable commitment from patients and their parents or carers, and progress can be slow. The topic expert suggested that approximately 30% of people who start treatment with the VB device do not complete treatment. It was suggested that one way to improve adherence to treatment may be to use new technology, for example three dimensional (3D) photographs, so that the patient can better visualise the ongoing improvement in their chest wall difference and hopefully continue using the VB device. The topic expert advised that a key factor in a patient's decision to continue treatment is their own desire to correct the PE, which outweighs the influence of their parents or carers.
5. The Council heard from a patient organisation, Pectus Matters, who described the impact that a chest wall difference can have on individuals. The physical effects for some people are significant, particularly for those whose cardiorespiratory functions are impacted. Pectus Matters also stressed the substantial psychological consequences of PE for some people. Young people and adolescents are especially susceptible to negative feelings and self-consciousness about their bodies. The resulting impact on their desire to participate in regular activities should not be underestimated.
6. The Council considered the costs of the VB device, including the first line treatment costs of VB device use, conservative management and surgery. Economic modelling comparing costs and effectiveness was not possible because of a lack of relative outcomes data. The Council highlighted the low cost of the VB device and the potential for the device to be good value for money, even if only a small portion of patients benefit from using the device.
7. The Council noted the reusable nature of the VB device, and the potential environmental and cost benefits for the service. The topic expert advised that a VB device is currently likely to only be used by two patients sequentially, because regular use and cleaning causes deterioration in the silicone VB device material.
8. The Council noted the importance of ongoing data collection by the Scottish National Chest Wall Service, and subsequent review of these data. The Scottish service has an established patient pathway for people with chest wall differences, and considerable experience of prescribing the VB device. Ongoing data collection will help further our understanding of, for example, the patients most likely to benefit from treatment and optimal treatment protocols.

Date of publication: 2 June 2025