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Objectives: The significant and rising cost of prescription drugs is a pressing concern for patients and payers. However, little is known about spending on and utilization of drugs prescribed by otolaryngologists. Methods: Utilizing publicly available Medicare Part D Prescriber Public Use data, we conducted a retrospective crosssectional analysis of 34 small-molecule drugs commonly prescribed by otolaryngologists (defined as 2017 Medicare Part D spending =$500 000) to Medicare beneficiaries. Prescription data was characterized by drug type (brand name vs generic). Primary outcomes for each prescription drug included the total annual cost and the total annual number of days supplied. Results: From 2013 to 2017, spending on drugs prescribed by otolaryngologists to Medicare beneficiaries decreased by $32.1 million ($131.7-$99.5 million; relative decrease 24.4%; compound annual growth rate [CAGR] -5.4%), while total utilization increased by 24.9 million days supplied (74.6-99.5 million; relative increase 33.3%; CAGR 5.9%). For brand name drugs, there was a decrease in spending ($71.1-$26.7 million; relative decrease -62.4%; CAGR -17.8%) and utilization (11.2-3.1 million days supplied; relative decrease -72.5%; CAGR -22.8%). In contrast, generic drugs demonstrated increased spending ($60.6-$72.8 million; relative increase 20.2%; CAGR 3.7%) and utilization (63.5-96.4 million days supplied; relative increase 51.9%; CAGR 8.7%). Conclusions: Spending on drugs prescribed by otolaryngologists to Medicare Part D beneficiaries declined between 2013 and 2017 in part due to a transition from brand name drugs to lower-cost generic equivalents. [ABSTRACT FROM AUTHOR]

In January 2021, the Centers for Medicare & Medicaid Services began requiring hospitals to publish price transparency files listing all prices negotiated with payers. We performed a cross-sectional analysis of payer-negotiated prices for commonly performed outpatient otolaryngology surgery at all hospitals scored by the US News & World Report in otolaryngology. We compared prices among hospitals (across-center ratios) and among payers at the same hospital (within-center ratios). Price disclosure rates were low overall for otolaryngologic surgery (maximum, 26.7% for bronchoscopy). Across-center ratios ranged from 3.5 (adjacent tissue transfer/rearrangement <10 cm2; raw median price range, $1384-$7047) to 18.6 (cochlear implant placement; raw median price range, $2417-$60,255). Median within-center ratios ranged between 2.7 (intraoperative navigation) and 5.4 (total thyroidectomy). Although price variation may signal opportunities for cost savings, patients may have limited ability to comparison shop due to hospital nondisclosure. Further investigation is necessary to examine the factors affecting price variation for otolaryngologic procedures. [ABSTRACT FROM AUTHOR]

In 2017, the Centers for Medicare and Medicaid Services transitioned clinicians to the Merit-Based Incentive Payment System (MIPS), the largest mandatory pay-for-performance program in health care history. The first full MIPS program year was 2018, during which the Centers for Medicare and Medicaid Services raised participation requirements and performance thresholds. Using publicly available Medicare data, we conducted a retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS in 2017 and 2018. In 2018, otolaryngologists reporting as individuals were less likely (P <.001) to earn positive payment adjustments (n = 1076/1584, 67.9%) than those participating as groups (n = 2802/2804, 99.9%) or in alternative payment models (n = 1705/1705, 100.0%). Approximately one-third (n = 1286/4472, 28.8%) of otolaryngologists changed reporting affiliations between 2017 and 2018. Otolaryngologists who transitioned from reporting as individuals to participating in alternative payment models (n = 137, 3.1%) achieved the greatest performance score improvements (median change, +23.4 points; interquartile range, 12.0-65.5). These findings have important implications for solo and independent otolaryngology practices in the era of value-based care. [ABSTRACT FROM AUTHOR]

Objectives: Functional dysphonia (FD) is one of the possible presentations of chronic dysphonia. Defined as dysphonia without gross abnormality of the larynx, FD manifests as aberrant muscle contractions resulting in mild‐to‐severe dysphonia. Despite increasing clinical awareness, diagnosis, and treatment strategies for FD remain challenging. Study Design: Institutional review board. Methods: A retrospective review of videostroboscopic examinations and EMR data from 109 patients treated for FD was performed. Videostroboscopy was analyzed by two independent reviewers and classified by laryngeal posturing and observer‐rated quality of voice. Medical records were reviewed and patient characteristics, history of disease, and survey responses were collected. Statistics were calculated using JMP and SAS packages. Results: A total of 85.1% of subjects were female and the average voice handicap index (VHI30) score was 71.0/120. Average time to diagnosis of FD was 688 days and average time from diagnosis to treatment was 3.7 days. 44.0% of patients exhibited hyperadducted laryngeal posturing, 31.9% hypoadducted, and 24.2% showed a mixed posture. 98% of patient voices improved after treatment. 85% returned to normal voice and 10% maintained a mild residual dysphonia. Conclusion: We describe here a large cohort of patients affected by FD, including clinical presentation and videostroboscopic findings. Our data show that most individuals with FD improve after specialized voice therapy once correctly diagnosed but that correct diagnosis and proper treatment was often significantly delayed. Level of Evidence: 4—Case‐series Laryngoscope, 131:E1957–E1964, 2021 [ABSTRACT FROM AUTHOR]

Inflammation drives the growth of tumors and is an important predictor of cancer aggressiveness. CD68, a marker of tumor‐associated macrophages (TAM), is routinely used to aid in prognosis and treatment choices for breast cancer patients. We report that thrombospondin‐4 (TSP‐4) mediates breast cancer inflammation and growth in mouse models in response to hyperglycemia and TGF‐beta by increasing TAM infiltration and production of inflammatory signals in tumors. Analysis of breast cancers and noncancerous tissue specimens from hyperglycemic patients revealed that levels of TSP‐4 and of macrophage marker CD68 are upregulated in diabetic tissues. TSP‐4 was colocalized with macrophages in cancer tissues. Bone‐marrow‐derived macrophages (BMDM) responded to high glucose and TGF‐beta by upregulating TSP‐4 production and expression, as well as the expression of inflammatory markers. We report a novel function for TSP‐4 in breast cancer: regulation of TAM infiltration and inflammation. The results of our study provide new insights into regulation of cancer growth by hyperglycemia and TGF‐beta and suggest TSP‐4 as a potential therapeutic target. What's new? Thrombospondin‐4 (TSP‐4), a secreted extracellular protein, is upregulated in several cancers, including breast cancer. TSP‐4 also is associated with diabetes, in which hyperglycemia influences inflammation and potentially increases cancer risk. This study shows that TSP‐4 is linked to inflammation and infiltration of macrophages in samples from breast cancer patients and in mouse models of breast cancer. Moreover, in breast tumors from hyperglycemic animals, TSP‐4 mediated the effects of hyperglycemia and TGF‐beta on cancer growth and inflammation. The findings highlight the influence of TSP‐4 on cancer inflammation and growth and warrant further study of TSP‐4 as a possible therapeutic target. [ABSTRACT FROM AUTHOR]

Background: The role of smoking among patients with human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) is unclear. Methods: A retrospective cohort study of patients with HPV(+) OPSCC from 2001 to 2015 at a tertiary‐care institution was conducted. The primary outcome was overall survival (OS). Results: Among 484 included patients, 94 (19.4%) were active smokers, 226 (46.7%) were former smokers, and 164 (33.9%) never smoked. Among active smokers, 82 patients (87.2%) had a ≥10 pack‐year and 69 (73.4%) had a ≥20 pack‐year smoking history. After adjusting for covariates, active smoking was a significant predictor of inferior OS (HR 2.28, P <.001) and PFS (HR 2.26, P <.001). When including pack‐years as the covariate, ≥20 pack‐years predicted a decreased effect‐size for inferior OS and PFS. Conclusions: For patients with HPV(+) OPSCC, active smoking at diagnosis is the most powerful covariate capturing smoking history to predict OS and PFS. [ABSTRACT FROM AUTHOR]