What we looked at and why

SHTG recommendation

In response to enquiry from the Scottish National Chest Wall Service

What were we asked to look at?

We were asked to assess the vacuum bell (VB) device for people with a pectus excavatum (PE). We were asked to consider clinical effectiveness, cost effectiveness, safety and patient issues, and we were also asked to look at other factors such as optimal wear time, whether effectiveness varies depending on the severity of the PE, and the optimal age for treatment.

Why is this important?

PE can be apparent from birth, or it can appear in young people following a growth spurt, typically between ages 11 and 14 years. It is caused by an abnormal growth of the cartilage ribs that attach to the breastbone, resulting in the front of the chest having a sunken appearance. In people who are only mildly affected, there are no negative effects on physical health. In more severe cases, PE may influence heart and lung function. For some people, the appearance of a chest wall difference can impact on their quality of life and psychological wellbeing. PE is the most common congenital chest wall difference, and the incidence is reported to be up to 8 per 1,000 live births. 

The VB device may be used by people with mild PEs to help improve quality of life, especially when no other treatment options are available. Use of the VB device may help reduce the need for surgery for people with a more pronounced PE, or may help to prevent a mild PE from becoming more severe during puberty.

What was our approach?

To produce our SHTG Recommendations we reviewed the published literature on the clinical and cost effectiveness, patient experience and safety of the VB device for the treatment of people with PE. A submission from the Pectus Matters patient group informed our recommendations. More information about SHTG Recommendations is available on our website.

What next?

Our recommendations will be shared with colleagues at the Scottish National Chest Wall Service to inform discussions on future service delivery. The Scottish National Chest Wall Service, which offers treatment to children and young people (aged 0 to 16 years) across Scotland, is an NHS National Services Scotland national specialist service.