46 results on '"Laryngoscopy economics"'
Search Results
2. Simulation of pediatric intubation using a low-cost videolaryngoscope in the setting of the COVID-19 pandemic.
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Rufach D, Santos S, and Terebiznik M
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- Argentina, COVID-19 transmission, Clinical Competence statistics & numerical data, Education, Medical, Continuing methods, Health Care Costs, Humans, Infant, Internship and Residency methods, Intubation, Intratracheal economics, Intubation, Intratracheal methods, Laryngoscopy economics, Laryngoscopy instrumentation, Laryngoscopy methods, Learning Curve, Manikins, Pediatrics economics, Time Factors, Video Recording, COVID-19 prevention & control, Intubation, Intratracheal instrumentation, Laryngoscopes economics, Laryngoscopy education, Pediatrics education, Simulation Training methods
- Abstract
In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope. Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8- 148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001). A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice., Competing Interests: None, (Sociedad Argentina de Pediatría.)
- Published
- 2021
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3. Thinking Outside the Box: A Low-cost and Pragmatic Alternative to Aerosol Boxes for Endotracheal Intubation of COVID-19 Patients.
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Brown H, Preston D, and Bhoja R
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- COVID-19, Coronavirus Infections therapy, Humans, Intubation, Intratracheal adverse effects, Intubation, Intratracheal methods, Laryngoscopy economics, Laryngoscopy methods, Manikins, Pneumonia, Viral therapy, SARS-CoV-2, Aerosols adverse effects, Betacoronavirus, Coronavirus Infections economics, Cost-Benefit Analysis methods, Intubation, Intratracheal economics, Pandemics economics, Pneumonia, Viral economics, Surgical Drapes economics
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- 2020
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4. Safety and cost of drug-induced sleep endoscopy outside the operating room.
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Bergeron M, Lee DR, DeMarcantonio MA, Kandil A, Mahmoud MA, Fleck RJ, and Ishman SL
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- Adenoidectomy, Adolescent, Child, Child, Preschool, Female, Humans, Laryngoscopy adverse effects, Male, Operating Rooms, Prospective Studies, Sleep, Tonsillectomy, Anesthesia, Costs and Cost Analysis, Laryngoscopy economics, Laryngoscopy methods, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive surgery
- Abstract
Introduction: Drug-induced sleep endoscopy (DISE) is used to assess site of obstruction for patients in a pharmacologically induced sleep-like state. It is traditionally performed in the operating room (OR), however, no data exists regarding the feasibility of this intervention outside the OR in children. The objective is to compare the safety of DISE performed in the MRI induction room to those performed in the OR., Methods: Prospective case-series of patients undergoing DISE in the MRI induction room (study group) to those assessed in the OR (controls) in a single-institution pediatric tertiary care center. Consecutive patients undergoing DISE examination for persistent obstructive sleep apnea (OSA) after adenotonsillectomy from September 2016 to September 2017 were included., Results: Overall, 118 patients (38 study patients, 80 controls) with a mean age of 10.6 years (95% confidence interval [CI], 9.3-11.9) underwent DISE; 39.8% (47/118) were female. The most frequent comorbidity was cardiac disease (22.0%, 26/118). The mean obstructive apnea-hypopnea index was 12.2 events/hour (95% CI, 8.8-15.6) for controls and 13.5 events/hour (95% CI, 8.7-18.3) for study patients (P = .76). No major complication or unplanned admissions occurred in either group. Induction time was similar (12 vs. 13 minutes, P = .7) as was total procedure time (12 vs. 14 minutes, P = .3) for procedures performed in both settings., Conclusion: There were no significant complications for DISE performed in the OR or the MRI induction room and procedure times were similar. Further assessment of patient outcomes and resource utilization is needed., Level of Evidence: 4 Laryngoscope, 130: 2076-2080, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2020
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5. Routine Preoperative Laryngoscopy for Thyroid Surgery Is Not Necessary Without Risk Factors.
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Maher DI, Goare S, Forrest E, Grodski S, Serpell JW, and Lee JC
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- Adolescent, Adult, Aged, Aged, 80 and over, Case-Control Studies, Cost Savings, Female, Humans, Incidence, Intraoperative Neurophysiological Monitoring, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications prevention & control, Retrospective Studies, Risk Factors, Thyroidectomy adverse effects, Thyroidectomy economics, Vocal Cord Paralysis economics, Young Adult, Laryngoscopy economics, Preoperative Care, Thyroid Gland surgery, Vocal Cord Paralysis epidemiology, Vocal Cord Paralysis prevention & control
- Abstract
Background: Routine preoperative vocal cord (VC) assessment with laryngoscopy in patients undergoing thyroidectomy allows clear documentation of baseline VC function, aids in surgical planning in patients with palsies, and facilitates interpretation of intraoperative neuromonitoring (IONM) findings. We aimed to determine the incidence of preoperative vocal cord palsy (VCP); to evaluate the associated risk factors for preoperative VCP; and to calculate the cost-savings potential of implementing a selective approach. Methods: Patients with a pre-thyroidectomy VC assessment by fiberoptic laryngoscopy were retrospectively recruited from the Monash University Endocrine Surgery Unit database from 2000 to 2018. Cases with preoperative VCP were reviewed for potential contributing factors and compared with a non-palsy cohort. Results: Of the 5987 patients who had preoperative laryngoscopy, VCP was documented in 41 (0.68%) patients. Four clinical parameters were found to be potential indicators of VCP, including: age ( p < 0.001), nodule ≥3.5 cm recorded on ultrasound imaging ( p = 0.01), presence of voice symptoms ( p < 0.001), and previous neck surgery ( p < 0.001). Malignant cytology ( p = 0.5) and exposure to head and neck irradiation were not different between the groups. Utilizing these risk factors, 2354 (39%) patients had at least one feature that may raise suspicion for preoperative VCP. By performing preoperative laryngoscopy only on this subset of patients, the potential cost savings exceeds 400 Australian Dollars per patient. Conclusions: Using this large dataset, we have established that a VCP is rare in the absence of a large nodule, hoarseness, or previous neck surgery. Therefore, in the era of IONM, we support a selective approach to preoperative laryngoscopy by using the aforementioned criteria.
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- 2019
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6. Cost Analysis of Channeled, Distal Chip Laryngoscope for In-office Laryngopharyngeal Biopsies.
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Marcus S, Timen M, Dion GR, Fritz MA, Branski RC, and Amin MR
- Subjects
- Cost-Benefit Analysis, Humans, Income, Laryngeal Diseases economics, Laryngeal Diseases therapy, Office Visits economics, Pharyngeal Diseases economics, Pharyngeal Diseases therapy, Predictive Value of Tests, Prognosis, Reproducibility of Results, Retrospective Studies, Ambulatory Surgical Procedures economics, Biopsy economics, Health Care Costs, Laryngeal Diseases pathology, Laryngoscopy economics, Pharyngeal Diseases pathology
- Abstract
Objective: Given that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy., Study Design: Retrospective, financial analyses were performed., Methods: Patients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded., Results: Of the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment., Conclusion: In-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2019
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7. Use of the pediatric intensive care unit for post-procedural monitoring in young children following microlaryngobronchoscopy: Impact on resource utilization and hospital cost.
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Kerris EJ, Patregnani JT, Sharron M, and Sochet AA
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- Bronchoscopy economics, Female, Humans, Infant, Intensive Care Units, Pediatric economics, Laryngoscopy economics, Length of Stay economics, Length of Stay statistics & numerical data, Male, Postoperative Complications etiology, Postoperative Complications therapy, Retrospective Studies, Bronchoscopy adverse effects, Bronchoscopy statistics & numerical data, Hospital Costs statistics & numerical data, Intensive Care Units, Pediatric statistics & numerical data, Laryngoscopy adverse effects, Laryngoscopy statistics & numerical data
- Abstract
Objective: To assess the frequency of post-procedural complications, medical interventions, and hospital costs associated with microlaryngobronchoscopy (MLB) in children prophylactically admitted for pediatric intensive care unit (PICU) monitoring for age ≤ 2 years., Methods: We performed a single-center, retrospective, descriptive study within a 44-bed PICU in a stand-alone, tertiary, pediatric referral center. Inclusion criteria were age ≤2 years and pre-procedural selection of prophylactic PICU monitoring after MLB between January 2010 and December 2015. Children were excluded for existing tracheostomy, if undergoing concurrent non-otolaryngeal procedures, or if intubated at the time of PICU admission. Primary outcomes were the development of major and minor procedural complications and medical rescue interventions. Secondary outcomes were hospital cost and length of stay (LOS)., Results: One hundred and eight subjects met inclusion criteria with a median age of 5.3 (IQR: 2.6-10.9) months. A majority (86%) underwent therapeutic instrumentation in addition to diagnostic MLB. There were no observed major complications or rescue interventions. Minor complications were noted within 5 h of monitoring and included isolated stridor (24%), desaturation <90% (10%), and nausea/emesis (8%). Minor interventions included supplemental oxygen via regular nasal cannula (39%), single-dose inhaled racemic epinephrine (19%), single-dose systemic corticosteroids (19%), or high flow nasal cannula (HFNC) therapy (4%). Save for two cases of HFNC, interventions were completed or discontinued within 5 h. Median PICU LOS was 1.1 days and median cost was $9650 (IQR: $8235- $14,861) per encounter. Estimated cost of same day observation in our post anesthesia care unit (PACU) following MLB without PICU admission is $1921 per encounter., Conclusions: In children ≤ 2 years of age prophylactically admitted for PICU observation, we did not observe severe complications or major interventions after MLB. Minor interventions and complications were noted early during post-procedural monitoring. PICU monitoring was substantially more expensive than same-day PACU observation. Young age as the sole criteria for prophylactic PICU monitoring after diagnostic or therapeutic MLB may be unjustified when comparable, cost-conscious care can be achieved in a PACU setting. Prior to pre-procedural selection of PICU monitoring, we recommend a broad contextual risk assessment including a review of comorbidities, operative plan, and intended anesthetic exposure., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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8. Life Cycle Assessment and Costing Methods for Device Procurement: Comparing Reusable and Single-Use Disposable Laryngoscopes.
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Sherman JD, Raibley LA 4th, and Eckelman MJ
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- Carbon Dioxide, Conservation of Natural Resources, Costs and Cost Analysis, Environmental Pollutants, Humans, Plastics, Risk, Stainless Steel, Surgical Instruments economics, Disposable Equipment economics, Equipment Reuse economics, Laryngoscopes economics, Laryngoscopes standards, Laryngoscopy economics, Laryngoscopy instrumentation
- Abstract
Background: Traditional medical device procurement criteria include efficacy and safety, ease of use and handling, and procurement costs. However, little information is available about life cycle environmental impacts of the production, use, and disposal of medical devices, or about costs incurred after purchase. Reusable and disposable laryngoscopes are of current interest to anesthesiologists. Facing mounting pressure to quickly meet or exceed conflicting infection prevention guidelines and oversight body recommendations, many institutions may be electively switching to single-use disposable (SUD) rigid laryngoscopes or overcleaning reusables, potentially increasing both costs and waste generation. This study provides quantitative comparisons of environmental impacts and total cost of ownership among laryngoscope options, which can aid procurement decision making to benefit facilities and public health., Methods: We describe cradle-to-grave life cycle assessment (LCA) and life cycle costing (LCC) methods and apply these to reusable and SUD metal and plastic laryngoscope handles and tongue blade alternatives at Yale-New Haven Hospital (YNHH). The US Environmental Protection Agency's Tool for the Reduction and Assessment of Chemical and other environmental Impacts (TRACI) life cycle impact assessment method was used to model environmental impacts of greenhouse gases and other pollutant emissions., Results: The SUD plastic handle generates an estimated 16-18 times more life cycle carbon dioxide equivalents (CO2-eq) than traditional low-level disinfection of the reusable steel handle. The SUD plastic tongue blade generates an estimated 5-6 times more CO2-eq than the reusable steel blade treated with high-level disinfection. SUD metal components generated much higher emissions than all alternatives. Both the SUD handle and SUD blade increased life cycle costs compared to the various reusable cleaning scenarios at YNHH. When extrapolated over 1 year (60,000 intubations), estimated costs increased between $495,000 and $604,000 for SUD handles and between $180,000 and $265,000 for SUD blades, compared to reusables, depending on cleaning scenario and assuming 4000 (rated) uses. Considering device attrition, reusable handles would be more economical than SUDs if they last through 4-5 uses, and reusable blades 5-7 uses, before loss., Conclusions: LCA and LCC are feasible methods to ease interpretation of environmental impacts and facility costs when weighing device procurement options. While management practices vary between institutions, all standard methods of cleaning were evaluated and sensitivity analyses performed so that results are widely applicable. For YNHH, the reusable options presented a considerable cost advantage, in addition to offering a better option environmentally. Avoiding overcleaning reusable laryngoscope handles and blades is desirable from an environmental perspective. Costs may vary between facilities, and LCC methodology demonstrates the importance of time-motion labor analysis when comparing reusable and disposable device options.
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- 2018
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9. Cost Effectiveness of Routine Laryngoscopy in the Surgical Treatment of Differentiated Thyroid Cancer.
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Zanocco K, Kaltman DJ, Wu JX, Fingeret A, Heller KS, Lee JA, Yeh MW, Sosa JA, and Sturgeon C
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- Cost-Benefit Analysis, Decision Trees, Humans, Laryngoscopy statistics & numerical data, Markov Chains, Prognosis, Quality-Adjusted Life Years, Thyroid Neoplasms pathology, Thyroid Neoplasms surgery, Thyroidectomy statistics & numerical data, Laryngoscopy economics, Thyroid Neoplasms economics, Thyroidectomy economics
- Abstract
Background: Some surgeons perform flexible fiberoptic laryngoscopy (FFL) in all patients prior to thyroid cancer operations. Given the low likelihood of recurrent laryngeal nerve (RLN) or aerodigestive invasion in clinically low-risk thyroid cancers, the value of routine FFL in this group is controversial. We hypothesized that routine preoperative FFL would not be cost effective in low-risk differentiated thyroid cancer (DTC)., Methods: A decision model was constructed comparing preoperative FFL versus surgery without FFL in a clinical stage T2 N0 DTC patient without voice symptoms. Total thyroidectomy and definitive hemithyroidectomy were both modeled as possible initial surgical approaches. Outcome probabilities and their corresponding utilities were estimated via literature review, and costs were estimated using Medicare reimbursement data. Sensitivity analysis was conducted to examine the uncertainty of cost, probability, and utility estimates in the model., Results: When the initial surgical strategy was total thyroidectomy, routine preoperative FFL produced an incremental cost of $183 and an incremental effectiveness of 0.000126 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) for routine FFL prior to total thyroidectomy was $1.45 million/QALY, exceeding the $100,000/QALY threshold for cost effectiveness. Routine FFL became cost effective if the preoperative probability of asymptomatic vocal cord paralysis increased from 1.0% to 4.9%, or if the cost of preoperative FFL decreased from $128 to $27. Changing the extent of initial surgery to hemithyroidectomy produced a higher ICER for routine FFL of $1.7 million/QALY., Conclusion: Routine preoperative FFL is not cost effective in asymptomatic patients with sonographically low-risk DTC, regardless of the initial planned extent of surgery.
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- 2018
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10. A Preliminary Case Report of a High-Quality Cost-effective Rigid Laryngoscopy Setup.
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Zhang F, McMurray JS, Devine EE, Xue C, McCulloch TM, and Jiang JJ
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- Cost-Benefit Analysis, Humans, Image Enhancement methods, Laryngoscopes standards, Reproducibility of Results, Laryngoscopy economics, Laryngoscopy instrumentation, Laryngoscopy methods, Lighting instrumentation, Lighting methods, Otorhinolaryngologic Diseases diagnosis
- Abstract
Objective: To evaluate a cost-effective modified rigid laryngoscopy setup with a portable light source and high-resolution commercially available digital camera for use in smaller otolaryngology and family practice clinics., Methods: The modified setup was used to obtain images of the larynx using both a traditional light source and a portable light source. Varying shutter speeds and ISOs were evaluated, and the optimal settings were determined for the modified setup., Results: Picture quality was adequate, and the portable light source was bright enough. ISO from 640 to 1600 with shutter speeds ranging from 1/60 to 1/160 are ideal under the normal light source, while it is better to set the ISO between 4000 and 10 000 with shutter speeds from 1/60 to 1/100 under the portable light source. Picture quality was adequate with a resolution of 2768 pixels × 1848 pixels with 350 dpi × 350 dpi., Conclusions: Results show that the modified setup obtains images of adequate quality for use in the clinic. Additionally, since the larynx requires the most illumination for endoscopic imaging, a similar setup would work for imaging the ear and nose. This setup may make laryngoscopic exams more accessible to patients at smaller laryngoscopy clinics or family practice providers.
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- 2017
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11. Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments.
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Naunheim MR, Song PC, Franco RA, Alkire BC, and Shrime MG
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- Adult, Decision Trees, Female, Humans, Laryngoscopy methods, Male, Middle Aged, Quality-Adjusted Life Years, Severity of Illness Index, Tracheostomy methods, Vocal Cord Paralysis diagnosis, Vocal Cord Paralysis economics, Cost-Benefit Analysis, Hospital Costs, Laryngoscopy economics, Tracheostomy economics, Vocal Cord Paralysis surgery
- Abstract
Objectives/hypothesis: Endoscopic management of bilateral vocal fold paralysis (BVFP) includes cordotomy and arytenoidectomy, and has become a well-accepted alternative to tracheostomy. However, the costs and quality-of-life benefits of endoscopic management have not been examined with formal economic analysis. This study undertakes a cost-effectiveness analysis of tracheostomy versus endoscopic management of BVFP., Study Design: Cost-effectiveness analysis., Methods: A literature review identified a range of costs and outcomes associated with surgical options for BVFP. Additional costs were derived from Medicare reimbursement data; all were adjusted to 2014 dollars. Cost-effectiveness analysis evaluated both therapeutic strategies in short-term and long-term scenarios. Probabilistic sensitivity analysis was used to assess confidence levels regarding the economic evaluation., Results: The incremental cost effectiveness ratio for endoscopic management versus tracheostomy is $31,600.06 per quality-adjusted life year (QALY), indicating that endoscopic management is the cost-effective short-term strategy at a willingness-to-pay (WTP) threshold of $50,000/QALY. The probability that endoscopic management is more cost-effective than tracheostomy at this WTP is 65.1%. Threshold analysis demonstrated that the model is sensitive to both utilities and cost in the short-term scenario. When costs of long-term care are included, tracheostomy is dominated by endoscopic management, indicating the cost-effectiveness of endoscopic management at any WTP., Conclusions: Endoscopic management of BVFP appears to be more cost-effective than tracheostomy. Though endoscopic cordotomy and arytenoidectomy require expertise and specialized equipment, this model demonstrates utility gains and long-term cost advantages to an endoscopic strategy. These findings are limited by the relative paucity of robust utility data and emphasize the need for further economic analysis in otolaryngology., Level of Evidence: NA Laryngoscope, 127:691-697, 2017., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2017
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12. Economic impact of recurrent respiratory papillomas in a UK adult population.
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Harrison A, Montgomery J, and Macgregor FB
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- Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Papillomavirus Infections therapy, Respiratory Tract Infections therapy, Scotland, State Medicine, United Kingdom, Young Adult, Health Services statistics & numerical data, Laryngoscopy economics, Papillomavirus Infections economics, Respiratory Tract Infections economics, Sick Leave economics, Speech Therapy economics
- Abstract
Objective: To calculate the financial burden of recurrent respiratory papilloma. This study is UK-based, where up until now no financial estimates have been calculated for this group of patients., Background: Recurrent respiratory papilloma is caused by the human papilloma virus (subtypes 6 and 11). The burden for the patient and the healthcare system is significant given the recurrent nature of the disease., Methods: Data were collected, using a questionnaire completed during routine clinical follow up, from a single centre managing recurrent respiratory papilloma in Glasgow, Scotland. Cost information was sourced from the Scottish Government's Information Services Division., Results: Fourteen patients with active recurrent respiratory papilloma between 2013 and 2014 were identified. The direct measurable cost to NHS Greater Glasgow and Clyde amounted to £107 478., Conclusion: Recurrent respiratory papilloma is a benign condition, but the financial implications of diagnosis are significant. Recurrent respiratory papilloma has a natural history of relapse and remission, and patients may require healthcare input over a period of several years.
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- 2016
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13. A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room.
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Hillel AT, Ochsner MC, Johns MM 3rd, and Klein AM
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- Adult, Ambulatory Surgical Procedures methods, Case-Control Studies, Female, Humans, Laryngoplasty methods, Laryngoscopy economics, Laryngoscopy methods, Male, Retrospective Studies, Ambulatory Surgical Procedures economics, Costs and Cost Analysis, Laryngoplasty economics, Operating Rooms economics, Operative Time
- Abstract
Objectives/hypothesis: To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR)., Study Design: Retrospective review of billing records., Methods: Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures., Results: Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures., Conclusions: For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures., Level of Evidence: NA Laryngoscope, 126:1385-1389, 2016., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2016
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14. A low-cost alternative for nasolaryngoscopy simulation training equipment: a randomised controlled trial.
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Johnston DI, Selimi V, Chang A, and Smith M
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- Adult, Clinical Competence, Computer Simulation economics, Cost-Benefit Analysis, Humans, Laryngoscopy education, Manikins, Nose, Otolaryngology education, Single-Blind Method, Laryngoscopes economics, Laryngoscopy economics, Otolaryngology economics
- Abstract
Objectives: Flexible nasolaryngoscopy is a key diagnostic procedure used in many specialities. Simulation-based teaching is beneficial for endoscopy training, but it is expensive. This study assessed whether an inexpensive simulation model is an effective training method for flexible nasolaryngoscopy., Methods: A three-armed, randomised, controlled trial was performed. One group received no simulation training, while two others were trained with either a high-cost or a low-cost model. All candidates then performed flexible nasolaryngoscopy on a volunteer. Their ability to perform this task was assessed by the patient discomfort score and time taken by a blinded expert., Results: Simulation-based teaching reduced patient discomfort and improved candidate skill level. Low-cost model training did not have a negative effect when compared with high-cost model training., Conclusion: Simulated flexible nasolaryngoscopy training may be more accessible with the use of an effective low-cost model.
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- 2015
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15. Analysis of Charges Associated with Definitive Nonsurgical Therapy for Early-Stage Lateralized Tonsil Cancer.
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Lewis CM, Chronowski GM, Dong W, Gunn GB, Rosenthal DI, and Weber RS
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- Antineoplastic Agents economics, Carcinoma mortality, Carcinoma pathology, Disease-Free Survival, Female, Gastrostomy economics, Humans, Laryngoscopy economics, Male, Middle Aged, Neck Dissection economics, Neoplasm Staging, Radiotherapy, Intensity-Modulated economics, Retrospective Studies, Survival Rate, Tonsillar Neoplasms mortality, Tonsillar Neoplasms pathology, Tonsillectomy economics, Carcinoma therapy, Fees, Medical, Tonsillar Neoplasms therapy
- Abstract
Objective: The cost of treatment as it affects comparative effectiveness is becoming increasingly more important. Because cost data are not readily available, we evaluated the charges associated with definitive nonsurgical therapy for early-stage lateralized tonsil cancers., Methods: Patients treated with unilateral radiation therapy (RT) for T1 or T2 tonsil cancer between 1995 and 2007 were retrospectively reviewed. Total and radiation-specific charges, from 3 months before to 4 months after radiation, were adjusted for inflation. All facets of treatment were evaluated for significant associations with total billing., Results: Eighty-four patients were identified. Three-year overall survival, disease-specific survival, and recurrence-free survival were 97 % [95 % confidence interval (CI) 0.88-0.99], 98 % (95 % CI 0.89-1), and 96 % (95 % CI 0.88-0.99), respectively. The median for radiation-specific charges was $60,412 (range $16,811-$84,792). The median for total charges associated with treatment was $109,917 (range $36,680-$231,895). Total billing for treatment was significantly associated with the year of diagnosis (p = 0.008), intensity-modulated radiation therapy versus wedge pair RT (p = 0.005), preradiation direct laryngoscopy (p < 0.0001), chemotherapy (p < 0.0001), gastrostomy tube placement (p = 0.004), and postradiation neck dissection (p = 0.005)., Conclusions: Although cost data for treatment are not readily available, historically, the recovery rate is approximately 30 %. The charges associated with definitive nonsurgical therapy for early-stage lateralized tonsil cancer have a wide range likely due to treatment-related procedures, the use of chemotherapy, and evolving RT technologies. These benchmark data are important given renewed interested in primary surgery for tonsil cancer. Cost of care, disease control, and functional outcomes will be critical for comparisons of effectiveness when selecting treatment modalities.
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- 2015
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16. Office-based narrow band imaging-guided flexible laryngoscopy tissue sampling: A cost-effectiveness analysis evaluating its impact on Taiwanese health insurance program.
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Fang TJ, Li HY, Liao CT, Chiang HC, and Chen IH
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- Case-Control Studies, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Retrospective Studies, Taiwan, Insurance, Health, Reimbursement, Laryngoscopy economics, Narrow Band Imaging economics, National Health Programs standards
- Abstract
Background/purpose: Narrow band imaging (NBI)-guided flexible laryngoscopy tissue sampling for laryngopharyngeal lesions is a novel technique. Patients underwent the procedure in an office-based setting without being sedated, which is different from the conventional technique performed using direct laryngoscopy. Although the feasibility and effects of this procedure were established, its financial impact on the institution and Taiwanese National Health Insurance program was not determined., Methods: This is a retrospective case-control study. From May 2010 to April 2011, 20 consecutive patients who underwent NBI flexible laryngoscopy tissue sampling were recruited. During the same period, another 20 age-, sex-, and lesion-matched cases were enrolled in the control group. The courses for procedures and financial status were analyzed and compared between groups., Results: Office-based NBI flexible laryngoscopy tissue sampling procedure took 27 minutes to be completed, while 191 minutes were required for the conventional technique. Average reimbursement for each case was New Taiwan Dollar (NT$)1264 for patients undergoing office-based NBI flexible laryngoscopy tissue sampling, while NT$10,913 for those undergoing conventional direct laryngoscopy in the operation room (p < 0.001). The institution suffered a loss of at least NT$690 when performing NBI flexible laryngoscopy tissue sampling., Conclusion: Office-based NBI flexible laryngoscopy tissue sampling is a cost-saving procedure for patients and the Taiwanese National Health Insurance program. It also saves the procedure time. However, the net financial loss for the institution and physician would limit its popularization unless reimbursement patterns are changed., (Copyright © 2013. Published by Elsevier B.V.)
- Published
- 2015
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17. Surgical team composition has a major impact on effectiveness and costs in laparoscopic donor nephrectomy.
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Özdemir-van Brunschot DM, Warlé MC, van der Jagt MF, Grutters JP, van Horne SB, Kloke HJ, van der Vliet JA, Langenhuijsen JF, and d'Ancona FC
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- Adult, Blood Loss, Surgical statistics & numerical data, Cohort Studies, Cost-Benefit Analysis, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Multivariate Analysis, Netherlands, Operative Time, Retrospective Studies, Treatment Outcome, Health Care Costs statistics & numerical data, Kidney Transplantation economics, Laryngoscopy economics, Living Donors, Medical Staff standards, Nephrectomy economics, Professional Competence standards
- Abstract
Purpose: Limited evidence exists that optimization of surgical team composition may improve effectiveness of laparoscopic donor nephrectomy (LDN)., Methods: A retrospective cohort study with 541 consecutive LDNs. From 2003 to 2012, surgical team composition was gradually optimized with regard to the surgeons' experience, proficient assistance and the use of fixed teams., Results: Multivariable analysis showed that a surgical team with an experienced surgeon had a significantly shorter operation time (OT) (-18 min, 95% CI -28 to -9), less estimated blood loss (EBL) (-64 mL, 95% CI -108 to -19) and shorter length of stay (LOS) (-1 day, 95% CI -1.6 to 0). Proficient assistance was also independently associated with a shorter OT (-43 min, 95% CI -53 to -33) and reduced EBL (-58 mL, 95% CI -109 to -6), whereas those procedures performed by fixed teams were related to a shorter operation (-50 min, 95% CI -59 to -43) and warm ischemia time (-1.8, 95% CI -2.1 to -1.5), a reduced mean complication grade (-0.14 per patient, 95% CI -0.3 to -0.02) and a shorter LOS (-1.1 day, 95% CI -1.7 to -05). Health care costs for LDN by one staff surgeon with unproficient assistance were 7.707 Euro, whereas costs for LDN by two staff surgeons in fixed teams were 5.614 Euro., Conclusions: Surgical team composition has a major impact on variables that reflect the effectiveness of LDN from the donors' perspective. Health care costs are lower for LDNs performed by two experienced surgeons in fixed team composition. We advocate the use of two experienced surgeons in fixed team composition for LDN.
- Published
- 2015
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18. Delayed otolaryngology referral for voice disorders increases health care costs.
- Author
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Cohen SM, Kim J, Roy N, and Courey M
- Subjects
- Adult, Aged, Ambulatory Care economics, Cost-Benefit Analysis, Female, Humans, Laryngeal Diseases complications, Linear Models, Male, Middle Aged, Physicians, Primary Care statistics & numerical data, Primary Health Care economics, Primary Health Care standards, Retrospective Studies, Time Factors, United States, Delayed Diagnosis economics, Health Care Costs statistics & numerical data, Laryngeal Diseases diagnosis, Laryngeal Diseases economics, Laryngoscopy economics, Otolaryngology economics, Practice Patterns, Physicians' economics, Referral and Consultation economics, Referral and Consultation standards, Voice Disorders economics, Voice Disorders etiology
- Abstract
Background: Despite the accepted role of laryngoscopy in assessing patients with laryngeal/voice disorders, controversy surrounds its timing. This study sought to determine how increased time from first primary care to first otolaryngology outpatient visit affected the health care costs of patients with laryngeal/voice disorders., Methods: Retrospective analysis of a large, national administrative claims database was performed. Patients had an International Classification of Diseases, 9(th) Revision-coded diagnosis of a laryngeal/voice disorder; initially saw a primary care physician and, subsequently, an otolaryngologist as outpatients; and provided 6 months of follow-up data after the first otolaryngology evaluation. The outpatient health care costs accrued from the first primary care outpatient visit through the 6 months after the first otolaryngology outpatient visit were determined., Results: There were 260,095 unique patients who saw a primary care physician as an outpatient for a laryngeal/voice disorder, with 8999 (3.5%) subsequently seeing an otolaryngologist and with 6 months postotolaryngology follow-up data. A generalized linear regression model revealed that, compared with patients who saw an otolaryngologist ≤1 month after the first primary care visit, patients in the >1-month and ≤3-months and >3-months time periods had relative mean cost increases of $271.34 (95% confidence interval $115.95-$426.73) and $711.38 (95% confidence interval $428.43-$993.34), respectively., Conclusions: Increased time from first primary care to first otolaryngology evaluation is associated with increased outpatient health care costs. Earlier otolaryngology examination may reduce health care expenditures in the evaluation and management of patients with laryngeal/voice disorders., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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19. Are new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective?
- Author
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Slinn SJ, Froom SR, Stacey MR, and Gildersleve CD
- Subjects
- Anesthesia economics, Child, Cost-Benefit Analysis, Humans, Laryngoscopy economics, Laryngoscopy instrumentation, Airway Management economics, Airway Management instrumentation, Intubation, Intratracheal economics, Intubation, Intratracheal instrumentation, Laryngoscopes economics
- Abstract
Over the past two decades, a plethora of new airway devices has become available to the pediatric anesthetist. While all have the laudable intention of improving patient care and some have proven clinical benefits, these devices are often costly and at times claims of an advantage over current equipment and techniques are marginal. Supraglottic airway devices are used in the majority of pediatric anesthetics delivered in the U.K., and airway-viewing devices provide an alternative for routine intubation as well as an option in the management of the difficult airway. Yet hidden beneath the convenience of the former and the technology of the latter, the impact on basic airway skills with a facemask and the lack of opportunities to fine-tune the core skill of intubation represent an unrecognised and unquantifiable cost. A judgement on this value must be factored into the absolute purchase cost and any potential benefits to the quality of patient care, thus blurring any judgement on cost-effectiveness that we might have. An overall value on cost-effectiveness though not in strict monetary terms can then be ascribed. In this review, we evaluate the role of these devices in the care of the pediatric patient and attempt to balance the advantages they offer against the cost they incur, both financial and environmental, and in any quality improvement they might offer in clinical care., (© 2014 John Wiley & Sons Ltd.)
- Published
- 2015
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20. Evaluating the cost-effectiveness of laryngeal examination after elective total thyroidectomy.
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Lang BH, Wong CK, Tsang RK, Wong KP, and Wong BY
- Subjects
- Decision Trees, Female, Follow-Up Studies, Humans, Laryngoscopy statistics & numerical data, Middle Aged, Models, Statistical, Prognosis, Quality-Adjusted Life Years, Thyroid Neoplasms pathology, Thyroid Neoplasms surgery, Thyroidectomy adverse effects, Vocal Cord Paralysis diagnosis, Vocal Cord Paralysis etiology, Cost-Benefit Analysis, Elective Surgical Procedures adverse effects, Laryngoscopy economics, Thyroid Neoplasms economics, Thyroidectomy economics, Vocal Cord Paralysis economics
- Abstract
Background: Although routine laryngeal examination (RLE) after thyroidectomy may cost more than selective laryngeal examination (SLE), it permits earlier detection and treatment of vocal cord palsy (VCP) and so may be cost-saving in the longer term. We compared the 2-year cost-effectiveness between RLE and SLE with RLE performed at 2 weeks (SLE-2w), 1 month (SLE-1m), and 3 months (SLE-3m) after thyroidectomy in the institution's perspective., Methods: Our case definition was a hypothetical 50-year-old woman who underwent an elective total thyroidectomy for a benign multinodular goiter. A decision-analytic model was constructed to compare the estimated cost-effectiveness between RLE, SLE-2w, SLE-1m, and SLE-3m after a 2-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year. Sensitivity and threshold analyses were used to examine model uncertainty., Results: RLE was not cost-effective because its incremental cost-effectiveness ratio to SLE-2w, SLE-1m, and SLE-3m were US$302,755, US$227,883 and US$247,105, respectively. RLE was only cost-effective when the temporary VCP rate increased >42.7 % or when the cost of RLE equaled zero. Similarly, SLE-2w was only cost-effective to SLE-3m when dysphonia for temporary VCP at 3 months increased >39.13 %, dysphonia for permanent VCP at 3 months increased >50.29 %, or dysphonia without VCP at 3 months increased >42.69 %. However, none of these scenarios appeared clinically likely., Conclusions: In the institution's perspective, RLE was not cost-effective against the other three SLE strategies. Regarding to the optimal timing of SLE, SLE-3m appears to be a reasonable and acceptable strategy because of its relative low overall cost.
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- 2014
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21. Inexpensive video-laryngoscopy guided intubation using a personal computer: initial experience of a novel technique.
- Author
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Karippacheril JG, Umesh G, and Ramkumar V
- Subjects
- Adolescent, Adult, Aged, Cost-Benefit Analysis, Equipment Design, Equipment Failure Analysis, Female, Humans, Image Interpretation, Computer-Assisted methods, India, Intubation, Intratracheal economics, Intubation, Intratracheal methods, Laryngoscopes economics, Laryngoscopy economics, Laryngoscopy methods, Male, Middle Aged, Pilot Projects, Reproducibility of Results, Sensitivity and Specificity, Video Recording economics, Young Adult, Image Interpretation, Computer-Assisted instrumentation, Intubation, Intratracheal instrumentation, Laryngoscopy instrumentation, Video Recording instrumentation
- Abstract
Video-laryngoscopy may provide an enhanced view of laryngeal structures compared to direct visualization. Commercial video-laryngoscopes are often expensive, limiting its adoption for routine use. We describe our initial experience using an inexpensive custom made device. Patients >15 years age, were randomly chosen, after informed consent, for video-laryngoscopy. A custom device easily assembled using an USB endoscopic camera, a conventional Macintosh laryngoscope blade size 3 or 4, and a personal computer was used. Patients with Mallampati class 1-3 were chosen. Video-laryngoscopy was recorded and reviewed. Twenty-four patients aged 16-68 years, of mean weight 58.46 ± 12.54 (40-86) kg were studied. The glottis could be visualized and intubation could be performed in all patients with 22/24 patients on first attempt. Mean duration of laryngoscopy was 22.17 ± 12.78 (7-59) s. Time taken for intubation, was mean of 28.58 ± 21.01 (9-89) s. Three patients with anticipated difficult airways could be intubated on the first attempt. Minor blood staining of the airway was seen in the video in two patients. Cormack-Lehane laryngoscopy grade visualized was 1 in 9/24, 2 in 15/24 patients. Percentage of glottic opening score was 62.29 ± 28.40 (20-100) %. Real-time video could be captured in all cases. The custom-made, inexpensive, video-laryngoscopy device is safe and reliable for clinical use. Real-time visualization and endotracheal intubation were successful in all patients, including those with anticipated difficult airway. Further, this device helps in archiving the video of intubation.
- Published
- 2014
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22. Cost-minimisation and cost-effectiveness analysis comparing transoral CO₂ laser cordectomy, laryngofissure cordectomy and radiotherapy for the treatment of T1-2, N0, M0 glottic carcinoma.
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Diaz-de-Cerio P, Preciado J, Santaolalla F, and Sanchez-Del-Rey A
- Subjects
- Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Humans, Laryngeal Neoplasms pathology, Larynx pathology, Larynx radiation effects, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, Spain, Cost Savings economics, Laryngeal Neoplasms economics, Laryngeal Neoplasms radiotherapy, Laryngeal Neoplasms surgery, Laryngoscopy economics, Larynx surgery, Laser Therapy economics, Lasers, Gas therapeutic use, National Health Programs economics, Vocal Cords radiation effects, Vocal Cords surgery
- Abstract
The financial costs of laryngeal cancer treatment are a notable burden on healthcare budgets. In this study, we assess whether CO2 laser surgery is cheaper than radiotherapy or laryngofissure and cordectomy in the treatment of T1-2, N0, M0 glottic squamous cell carcinoma. 56 patients with a mean age of 65.88 years (SD = 10.04), 53 men and 3 women, with T1-2, N0, M0 glottic squamous cell carcinoma were retrospectively analysed. We conducted a comparative analysis of costs associated with three treatments: carbon dioxide laser cordectomy (n = 21), radiotherapy (n = 20), and laryngofissure cordectomy (n = 15). Complications of the radiotherapy and surgical treatments, need for tracheotomy and its permanence, length of hospital stay, occupation and ability to work and economic costs of treatments were recorded. Cost-minimisation and cost-effectiveness analysis were obtained. The cost of transoral laser cordectomy (2,289.79 euro) is statistically significantly lower than that of radiotherapy (4,804.72 euro) or laryngofissure cordectomy (13,229.75 euro) (p < 0.001). Transoral carbon dioxide laser surgery is the best option in terms of cost-effectiveness for the treatment of T1-2, N0, M0 glottic cancer.
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- 2013
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23. Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization.
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Crockett SD, Sperry SL, Miller CB, Shaheen NJ, and Dellon ES
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Emergency Service, Hospital economics, Endoscopy, Digestive System economics, Fees, Medical statistics & numerical data, Female, Foreign Bodies diagnosis, Foreign Bodies economics, Gastrointestinal Agents economics, Hospitals, University economics, Hospitals, University statistics & numerical data, Humans, Infant, Laryngoscopy economics, Length of Stay statistics & numerical data, Male, Middle Aged, North Carolina, Retrospective Studies, Time Factors, Young Adult, Emergency Service, Hospital statistics & numerical data, Endoscopy, Digestive System statistics & numerical data, Esophagus, Foreign Bodies therapy, Gastrointestinal Agents therapeutic use, Hospital Charges statistics & numerical data, Laryngoscopy statistics & numerical data
- Abstract
Esophageal foreign body impaction (EFBI) often requires urgent evaluation and treatment, but characteristics of emergency department (ED) care such as timing of presentation and therapeutic procedures and costs of care are unknown. We aimed to study health-care utilization for patients with EFBI presenting to the ED. Cases of EFBI from 2002 to 2009 were identified by querying three different databases from the University of North Carolina Hospitals for all records with ICD-9 CM code 935.1: 'foreign body in the esophagus.' Charts were reviewed to confirm EFBI and extract pertinent data related to the ED visit, including time of presentation, length of ED stay, medications administered, type of procedure performed, characteristics of procedures, and time to therapeutic procedure. Hospital charges for EFBI encounters and consult fees were determined from the Physicians' Fee Reference 2010, and were compiled to estimate costs. Of the 548 cases of EFBI identified, 351 subjects (64%) presented to the ED. A total of 118 (34%) patients received a medication to treat EFBI, which was only effective in 8% of those patients. Two hundred ninety (83%) subjects underwent a procedure including esophagogastroduodenoscopy (EGD) (n=206) or ear, nose, and throat surgery (ENT)-performed laryngoscopy/esophagoscopy (n=138). Admission to the hospital occurred in 162 (46%) of cases. There was no relationship between ED arrival time and time-to-procedure or total time in ED. There was also no significant relationship between delivery of ED medications and likelihood of undergoing a procedure, or between ED arrival time and delivery of medications. The charges associated with a typical EFBI episode ranged from $2284-$6218. In conclusion, the majority of patients with EFBI at our institution presented to the ED. Medical management was largely ineffective. A therapeutic procedure was required to clear the EFBI in most patients. Time of ED arrival made no difference in time-to-procedure, indicating that gastroenterology and ENT specialists recognize the urgency of treating EFBI regardless of time of day., (© 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.)
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- 2013
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24. Comparison of efficacy, safety, and cost-effectiveness of in-office cup forcep biopsies versus operating room biopsies for laryngopharyngeal tumors.
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Naidu H, Noordzij JP, Samim A, Jalisi S, and Grillone GA
- Subjects
- Anesthesia, General economics, Biopsy adverse effects, Biopsy instrumentation, Biopsy methods, Boston, Carcinoma, Squamous Cell economics, Cost-Benefit Analysis, Female, Humans, Laryngeal Neoplasms economics, Laryngoscopy economics, Male, Middle Aged, Neoplasm Staging economics, Patient Safety, Pharyngeal Neoplasms economics, Predictive Value of Tests, Retrospective Studies, Video Recording economics, Biopsy economics, Carcinoma, Squamous Cell pathology, Hospital Costs, Hypopharynx pathology, Laryngeal Neoplasms pathology, Office Visits economics, Operating Rooms economics, Pharyngeal Neoplasms pathology, Surgical Instruments economics
- Abstract
Objective: To compare the diagnostic yield, safety, and cost of biopsies of laryngopharyngeal tumor performed in an office setting with those performed in the operating room (OR) under general anesthesia., Study Design: This was a retrospective review of patients' records at Boston Medical Center from 2006 to 2008., Methods: In-office biopsies were performed using flexible digital videolaryngoscopy with cup forcep biopsies taken via the working channel in patients in whom cancer was strongly suspected. Patients whose in-office biopsies were nondiagnostic or suspected to be falsely negative were taken to the OR for biopsy under general anesthesia and served as the control group., Results: Twelve patients fit the selection criteria and had in-office biopsies attempted. One patient could not tolerate the in-office biopsy. Seven of the 11 in-office biopsies performed were diagnostic for squamous cell carcinoma. The average cost (facility and professional otolaryngology charges) for an in-office biopsy was $2053.91. Five of these patients required further biopsy in the OR at an average cost (charges for surgeon, OR, anesthesia, and recovery room) of $9024.47. There were no significant complications reported for any of the procedures., Conclusions: In patients with strongly suspected laryngopharyngeal cancer, in-office cup forcep biopsies were 64% diagnostic. When compared with the OR, in-office cup biopsies of laryngopharyngeal tumor are safe and considerably more cost-effective. Although 36% of patients required operative biopsies, the cost would have been considerably higher in this cohort if all patients had gone to the OR for biopsies., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)
- Published
- 2012
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25. Low-cost high-speed imaging system for observing vocal fold vibration in voice disorders.
- Author
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Kaneko K, Sakaguchi K, Inoue M, and Takahashi H
- Subjects
- Cost-Benefit Analysis, Female, Humans, Laryngoscopy economics, Male, Vibration, Videotape Recording economics, Laryngoscopy methods, Larynx physiopathology, Signal Processing, Computer-Assisted, Videotape Recording methods, Vocal Cords physiopathology, Voice Disorders physiopathology
- Abstract
Purpose: The aim of this study was to establish a method to observe vocal fold vibration using a low-cost high-speed laryngeal imaging system., Procedures: We assembled a high-speed imaging system with a consumer digital camera and a rigid laryngeal endoscope. The camera can shoot digital images at a rate of 1,200 frames per second and be purchased for about USD 1,000 in Japan., Results: We examined the normal and pathological vocal folds of 215 subjects with our new system and analyzed the vocal fold vibration in these subjects by playback of a video and kymograph images., Conclusions: Our high-speed laryngeal imaging system is highly cost-effective and can be a useful tool for examining the vocal folds of patients with voice disorders., (Copyright © 2012 S. Karger AG, Basel.)
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- 2012
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26. Comparison of the tracheal intubation using Macintosh laryngoscope and GlideScope® videolaryngoscope by advanced cardiac life support providers in a manikin study.
- Author
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Yuan YJ, Xue FS, Wang Q, Liu JH, Xiong J, and Liao X
- Subjects
- Data Interpretation, Statistical, Endpoint Determination, Humans, Intubation, Intratracheal economics, Intubation, Intratracheal instrumentation, Laryngoscopy economics, Treatment Failure, Advanced Cardiac Life Support, Intubation, Intratracheal methods, Laryngoscopes economics, Laryngoscopy methods, Manikins
- Published
- 2011
27. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility?
- Author
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Higgins KM
- Subjects
- Canada, Costs and Cost Analysis, Decision Support Techniques, Glottis, Hospital Costs, Humans, Insurance, Health, Reimbursement, Laryngeal Neoplasms economics, Laryngeal Neoplasms pathology, Laryngeal Neoplasms radiotherapy, Laryngeal Neoplasms surgery, Quality-Adjusted Life Years, Treatment Outcome, Dose Fractionation, Radiation, Laryngoscopy economics, Laser Therapy economics, Lasers, Gas, Radiotherapy economics
- Abstract
Objectives/hypothesis: To determine which treatment for Tis/T1 glottic carcinoma among adult patients, transoral CO(2) laser excision (TOL) versus external beam radiation (XRT), is superior in terms of cost utility., Study Design: Cost-utility analysis., Methods: Six head-to-head comparison studies and 22 consecutive case series were identified to examine oncologic control. The case series were pooled as a composite group. Primary end points were local control (LC), laryngectomy-free survival (LFS), and overall survival (OS). Objective and subjective voice-quality measures were secondary end points. Third-party payer perspective was adopted for cost-utility analysis. Operational and capital costs were determined with the microcosting method. Rollback calculations and quality adjusted life years (QALYs) were calculated with decision-tree modeling., Results: There were no significant differences between TOL surgery and XRT with respect to LC (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.51-1.3) and LFS (OR, 0.84, 95% CI, 0.42-1.66). The weighted mean difference for OS was 0.03. There were no objective differences for measures of voice quality. Decision-tree analysis was undertaken using mean 5-year local control initial probabilities. CO(2) laser cost $2475.65/case (US $2407.32/case), generating 1.663 QALYs, whereas radiation cost $4965.85/case (US $4828.79/case), generating 1.506 QALYs. This contrasts initial upstream costs for CO(2) laser (∼$1889/case, ∼US $1836.86/case) and radiation (∼$2454.70/case, ∼US $2386.95/case)., Conclusions: This meta-analysis shows that there is no clear difference in oncologic outcome between TOL surgery and XRT. There is a trend for improved post-treatment voice quality with XRT, although the clinical significance of this is questionable. TOL surgery dominates XRT from a cost-utility standpoint primarily because of the enhanced downstream affordability of salvage treatment.
- Published
- 2011
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28. Nasolaryngoscopy in a family medicine clinic: indications, findings, and economics.
- Author
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Wilkins T, Gillies RA, Getz A, Zimmerman D, and Kang L
- Subjects
- Adult, Cost-Benefit Analysis, Family Practice economics, Female, Humans, Laryngeal Diseases physiopathology, Laryngoscopy economics, Male, Middle Aged, Retrospective Studies, Southeastern United States, Urban Health, Family Practice methods, Laryngeal Diseases diagnosis, Laryngoscopy methods, Nasopharyngeal Diseases diagnosis
- Abstract
Background: Nasopharyngeal complaints are common among patients who present to primary care. Patients with these complaints are often referred for nasolaryngoscopy evaluation to exclude serious conditions such as laryngeal cancer., Methods: This study is a retrospective case series in which 276 charts of adult outpatients who were referred for nasolaryngoscopy were reviewed. We examined patient demographics, procedure indications and findings, complications, and changes in clinical management., Results: Nasolaryngoscopy was completed in 273 (98.9%) patients (mean age, 51.3 +/- 14.6 years; 71.4% were women). The most common indications for nasolaryngoscopy were hoarseness (51.3%), globus sensation (32.0%), and chronic cough (17.1%); the most common findings included laryngopharyngeal reflux (42.5%), chronic rhinitis (32.2%), and vocal cord lesions (13.2%). Three patients (1.1%) were diagnosed with laryngeal cancer and this diagnosis was significantly associated with a history of smoking (P = .03). No major complications occurred., Conclusions: We found that nasolaryngoscopy was a safe procedure in the primary care setting, and no major complications occurred in our series. Patients who have ever smoked and complain of hoarseness are at higher risk for laryngeal cancer. An alarming 1% of patients in our series were diagnosed with laryngeal cancer. This is the first study to define the rates of laryngopharyngeal reflux, vocal cord lesions, and laryngeal cancer among primary care patients.
- Published
- 2010
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29. The cost-effectiveness of 18FDG-PET in selecting patients with suspicion of recurrent laryngeal carcinoma after radiotherapy for direct laryngoscopy.
- Author
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van Hooren AC, Brouwer J, de Bree R, Hoekstra OS, Leemans CR, and Uyl-de Groot CA
- Subjects
- Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Humans, Laryngeal Neoplasms diagnosis, Laryngeal Neoplasms radiotherapy, Male, Middle Aged, Sensitivity and Specificity, Fluorodeoxyglucose F18, Laryngeal Neoplasms diagnostic imaging, Laryngeal Neoplasms economics, Laryngoscopy economics, Neoplasm Recurrence, Local diagnostic imaging, Neoplasm Recurrence, Local economics, Positron-Emission Tomography economics, Radiopharmaceuticals
- Abstract
The aim of this study was to estimate the cost-effectiveness of (18)FDG-PET in the selection for direct laryngoscopy in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. The direct medical costs of 30 patients with suspicion of a recurrence were calculated from the first visit where suspicion was raised until one year after. A conventional strategy, in which all these patients underwent direct laryngoscopy, was compared to an (18)FDG-PET strategy in which only patients with a positive or equivocal (18)FDG-PET underwent direct laryngoscopy. A sensitivity analysis was performed to examine the influence of the type of camera and 'setting'. The mean costs of an (18)FDG-PET strategy were 399 euros less than a direct laryngoscopy strategy. The type of camera and setting had no influence. In patients with suspicion for recurrent laryngeal carcinoma after radiotherapy, (18)FDG-PET seems to be effective and less costly in selecting patients for direct laryngoscopy.
- Published
- 2009
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30. Head and neck cancer assessment by flexible endoscopy and telemedicine.
- Author
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Dorrian C, Ferguson J, Ah-See K, Barr C, Lalla K, van der Pol M, McKenzie L, and Wootton R
- Subjects
- Cost-Benefit Analysis, Feasibility Studies, Female, Greenhouse Effect, Head and Neck Neoplasms economics, Humans, Laryngoscopes, Male, National Health Programs economics, Pilot Projects, Rural Health Services, Scotland, Travel economics, Head and Neck Neoplasms diagnosis, Health Services Accessibility economics, Laryngoscopy economics, Referral and Consultation economics, Telemedicine economics
- Abstract
We have conducted a feasibility study to establish whether ENT tele-endoscopy would be a suitable method of service delivery for patients who live in the Shetland Islands. Ten clinics were conducted over a period of 17 months using ISDN-based videoconferencing at a bandwidth of 384 kbit/s. A total of 42 patients were seen in Aberdeen via videoconferencing for a head and neck cancer assessment. Feasibility was confirmed after the first 20 patients, following positive feedback from all concerned and the absence of any significant clinical or technical problems. A total of 42 journeys was avoided, each journey saving 123 kg CO(2) per person. A preliminary cost analysis showed that the threshold at which tele-ENT became cheaper than travel was a workload of 35 patients/year. The actual workload during the pilot study was 29 patients/year. A national telemedicine service for the initial assessment of potential malignancy has the potential to reduce unnecessary transfers to specialist centres, with accompanying reductions in carbon emissions.
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- 2009
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31. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques.
- Author
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Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, and Hunt S
- Subjects
- Aged, Cohort Studies, Endometrial Neoplasms economics, Female, Humans, Hysterectomy adverse effects, Hysterectomy economics, Hysterectomy methods, Laryngoscopy adverse effects, Laryngoscopy economics, Laryngoscopy methods, Lymph Node Excision adverse effects, Lymph Node Excision economics, Lymph Node Excision methods, Middle Aged, Neoplasm Staging, Retrospective Studies, Robotics economics, Robotics methods, Treatment Outcome, Endometrial Neoplasms pathology, Endometrial Neoplasms surgery
- Abstract
Objectives: The study purpose was to compare hysterectomy and lymphadenectomy completed via robotic assistance, laparotomy, and laparoscopy for endometrial cancer staging with respect to operative and peri-operative outcomes, complications, adequacy of staging, and cost., Methods: One hundred and ten patients underwent hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy for endometrial cancer staging. All cases were performed by a single surgeon, at a single institution (40 robotic, 40 laparotomy, and 30 laparoscopic) and were retrospectively reviewed to compare demographics and peri-operative variables including, operative time, estimated blood loss, lymph node count, hospital stay, complications, and return to normal activity. Additionally, a cost comparison between all three modalities was performed., Results: Patients undergoing robotic assisted hysterectomy and staging experienced longer operative time than the laparotomy cohort with no difference in comparison to the laparoscopic cohort (184 min, 108.6 min, 171 min, p<0.0001, p=0.14). Estimated blood loss was significantly reduced for the robotic cohort in comparison to the laparotomy cohort and comparable to laparoscopic cohort (166 cc, 316 cc, 253 cc, p=0.01, p=0.25). The complication rate was lowest in the robotic cohort (7.5%) relative to the laparotomy (27.5%) and laparoscopic cohorts (20%) (p=0.015, p=0.03). Average return to normal activity for the robotic patients was significantly shorter than those undergoing laparotomy (24.1 days versus 52 days, p<0.0001) and those undergoing laparoscopy (31.6 days, p=0.005). Lymph node retrieval did not differ between the 3 groups (robotic 17 nodes, laparotomy 14 nodes, laparoscopic 17 nodes). The total average cost for hysterectomy with staging completed via laparotomy was $12,943.60, for standard laparoscopy $7569.80, and for robotic assistance $8212.00. The difference in cost between laparotomy and robotic cohorts was significant p=0.0001 while there was no statistically significant difference in cost between laparoscopy and robotic cohorts p=0.06., Conclusions: Robotic hysterectomy provides comparable node retrieval to laparotomy and laparoscopic procedures in the case of the experienced laparoscopic surgeon. While robotic hysterectomy takes longer to perform than hysterectomy completed via laparotomy, it is equivalent to laparoscopic hysterectomy and provides the patient with a more expeditious return to normal activity with reduced post-operative morbidity. Additionally, the average cost for hysterectomy and staging was highest for laparotomy, followed by robotic, and least for standard laparoscopy.
- Published
- 2008
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32. Beyond the efficiency index: finding a better way to reduce overuse and increase efficiency in physician care.
- Author
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Greene RA, Beckman HB, and Mahoney T
- Subjects
- Cost Control, Drug Utilization, Efficiency, Organizational, Humans, Hypertension economics, Hypertension therapy, Laryngoscopy economics, Primary Health Care organization & administration, United States, Financial Management, Primary Health Care economics
- Abstract
Current strategies for addressing health care costs stress physician performance measurement and commonly use an efficiency index (EI). During seven years of conducting individual practitioner pay-for-performance (P4P), we found that using EIs hindered our work on reducing overuse of services. This paper offers an alternative approach through the identification of variation in key cost drivers. As proof of concept, we apply this model to hypertension care. We then describe a project that decreased apparent overuse of fiberoptic laryngoscopy among otorhinolaryngologists. Focusing directly on reducing overuse improves cost efficiency without the barriers imposed by EI methodology.
- Published
- 2008
- Full Text
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33. Cost-effective diagnosis of ingested foreign bodies.
- Author
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Shrime MG, Johnson PE, and Stewart MG
- Subjects
- Decision Trees, Foreign Bodies diagnostic imaging, Humans, Sensitivity and Specificity, Cost-Benefit Analysis, Deglutition, Esophagoscopy economics, Foreign Bodies diagnosis, Laryngoscopy economics, Tomography, X-Ray Computed economics
- Abstract
Objectives: To compare the cost effectiveness of plain film radiography, computed tomography (CT), and endoscopy as initial diagnostic modalities in adult patients complaining of retained ingested foreign bodies., Design: A systematic literature review was conducted to determine key statistics for the analysis, such as prevalence of disease, prevalence of complications, and the sensitivity and specificity of each diagnostic modality. Costs were estimated using 2006 Medicare reimbursement for hospital and professional fees. A deterministic cost-effectiveness analysis was then conducted using decision analysis software and a decision tree model to evaluate the various diagnostic strategies. After identifying initial results, we also performed sensitivity and threshold analysis to assess the strength of the recommendations., Results: We reviewed 316 abstracts, identified 16 pertinent studies that included a total of 7,088 patients with possible foreign bodies, and extracted key statistics from those papers. Decision analysis showed that CT scanning as an initial diagnostic strategy proved more cost effective than plain film or operative endoscopy. The incremental cost of immediate endoscopy for every additional correctly diagnosed patient was $5,238. Plain radiography was more costly and less effective, even with the addition of confirmatory CT scanning after a negative plain film. Sensitivity and threshold analyses demonstrated that these results are robust., Conclusions: Patients presenting with a complaint of a retained ingested foreign body are most cost-effectively managed with CT scan, after history and physical. Immediate endoscopy may be considered if CT is not available, although it adds significant cost. Plain films are dominated by these two diagnostic strategies.
- Published
- 2007
- Full Text
- View/download PDF
34. CPT coding for upper airway endoscopies.
- Author
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LeGrand M
- Subjects
- Documentation, Esophagoscopy economics, Esophagoscopy nursing, Humans, Laryngoscopy economics, Laryngoscopy nursing, Nurse Clinicians organization & administration, Nurse Practitioners organization & administration, Nurse's Role, Physician Assistants organization & administration, Physician's Role, Professional Autonomy, Current Procedural Terminology, Esophagoscopy classification, Insurance Claim Reporting, Laryngoscopy classification
- Abstract
The Spring issue (Rudy, 2005) of ORL-Head and Neck Nursing presented a broad review of endoscopic procedures for evaluation and management of upper airway problems. Zarnitz (2005) briefly addressed billing for the most commonly performed upper airway endoscopies in that issue. This paper presents, in detail, the coding for a wider range of upper airway endoscopies performed in the office setting, along with how to report them to third-party payors.
- Published
- 2006
35. Safety and cost-effectiveness of intra-office flexible videolaryngoscopy with transoral vocal fold injection in dysphagic patients.
- Author
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Andrade Filho PA, Carrau RL, and Buckmire RA
- Subjects
- Adult, Aged, Aged, 80 and over, Ambulatory Surgical Procedures economics, Ambulatory Surgical Procedures methods, Anesthesia, General economics, Anesthesia, Local economics, Aphasia economics, Cohort Studies, Cost-Benefit Analysis, Female, Humans, Injections, Laryngoscopy methods, Male, Middle Aged, Office Visits economics, Operating Rooms economics, Retrospective Studies, Treatment Outcome, Videotape Recording, Vocal Cords surgery, Aphasia therapy, Glottis physiopathology, Laryngoscopy economics, Laryngoscopy standards, Safety
- Abstract
Setting: A tertiary care referral-based otolaryngology practice., Objectives: To evaluate the safety of office-based transoral oral vocal fold injection in an ambulatory dysphagic population and to evaluate cost-effectiveness in comparison with traditional injection laryngoplasty done under general anesthesia in the operating room. Dysphagia is a nonspecific and common symptom of many head and neck and systemic disease processes. In patients with glottal incompetence, the presenting complaint of dysphagia generally portends to more global oropharyngeal dysfunction than dysphonia alone. Although many authors have reported on and advocated the use of office injection technique in the management of dysphonia caused by glottal insufficiency, there is a paucity of literature regarding the use of this technique in a more medically compromised dysphagic patient population (Ann Otol Rhinol Laryngol 1997;106:778-83). We describe our experience with vocal fold injection in the office setting using a transoral technique under flexible videolaryngoscopy for the treatment of glottal insufficiency in dysphagic patients. The safety and cost-effectiveness of this approach are highlighted.
- Published
- 2006
- Full Text
- View/download PDF
36. Mitomycin-c application in airway stenosis surgery: analysis of safety and costs.
- Author
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Ubell ML, Ettema SL, Toohill RJ, Simpson CB, and Merati AL
- Subjects
- Anesthesia, General economics, Cost-Benefit Analysis, Costs and Cost Analysis, Dilatation, Drug Costs, Female, Hospital Costs, Humans, Laryngoscopy economics, Laryngostenosis economics, Laser Therapy economics, Male, Middle Aged, Mitomycin adverse effects, Mitomycin economics, Nucleic Acid Synthesis Inhibitors adverse effects, Nucleic Acid Synthesis Inhibitors economics, Operating Rooms economics, Photography economics, Retrospective Studies, Time Factors, Tracheal Stenosis economics, Treatment Outcome, Laryngostenosis surgery, Mitomycin therapeutic use, Nucleic Acid Synthesis Inhibitors therapeutic use, Tracheal Stenosis surgery
- Abstract
Objective: This study describes a large series of patients receiving topical mitomycin-c (MMC) during airway surgery, including complications, and carries out a cost analysis for its use in laryngotracheal stenosis., Study Design and Setting: Retrospective review, tertiary center. Airway patients receiving MMC are reviewed for demographics, stenosis characteristics, and MMC usage. A basic cost analysis is carried out., Results: Fifty patients underwent 93 MMC applications (mean = 50.8 years, 25 male, 25 female). In 89 of 93 applications (96%), the concentration of MMC was 0.4 mg/ml. One major complication occurred (1.1%). The expense for MMC is $455; the mean cost for airway surgery is $7,840. It is estimated that if 1 of 17 MMC treated patients requires one less operation, the cost ratio is favorable., Conclusions: This large series contributes to literature that MMC is a safe adjunct to laryngotracheal surgery. The marginal cost for MMC application is favorable based on our basic cost analysis and existing efficacy data., Significance: Mitomycin-c seems to be safe and cost-effective in endoscopic airway surgery., Ebm Rating: C-4.
- Published
- 2006
- Full Text
- View/download PDF
37. Intubation laryngeal mask: atraumatic diagnostic tool in suspension laryngoscopy.
- Author
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Windfuhr JP and Remmert S
- Subjects
- Anesthesia, General, Biopsy economics, Cost-Benefit Analysis, Equipment Design, Humans, Laryngoscopy economics, Male, Middle Aged, Postoperative Hemorrhage prevention & control, Vocal Cords pathology, Vocal Cords surgery, Intubation, Intratracheal instrumentation, Laryngeal Masks, Laryngoscopy methods
- Abstract
Conclusion: The new technique of ILM-guided vocal cord biopsy and APC is safe, cost-effective and non-invasive. It provides excellent airway control, adequate exposure of the vocal cords and effective treatment of laryngeal bleeding., Objective: Suspension microlaryngoscopy is a standard diagnostic procedure for vocal cord biopsy. In experienced hands failure of the procedure is extremely rare and may indicate a need for more invasive techniques. The aim of this study was to present a new technique of laryngoscopy/vocal cord biopsy and to review the relevant literature., Material and Methods: After induction of general anesthesia and preoxygenation an intubation laryngeal mask (ILM) was inserted. A flexible bronchoscope was passed through the ILM and an anterior lesion was identified at the vocal cord. Biopsies were taken with forceps inserted through the instrument's working channel. The procedure was performed using video-endoscopic guidance. Bleeding from the wound surface was adequately treated with argon-plasma coagulation (APC)., Results: Identification of the vocal cords was readily accomplished using the ILM. Only four literature reports matched our search criteria; all used the standard laryngeal mask or other instruments such as a laser or did not use the procedure for definitive therapy.
- Published
- 2005
- Full Text
- View/download PDF
38. The role of airway fluoroscopy in the evaluation of stridor in children.
- Author
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Rudman DT, Elmaraghy CA, Shiels WE, and Wiet GJ
- Subjects
- Bronchi pathology, Bronchoscopy economics, Bronchoscopy methods, Child, Child, Preschool, Endoscopy economics, Endoscopy methods, Female, Fiber Optic Technology, Fluoroscopy economics, Fluoroscopy methods, Glottis pathology, Humans, Infant, Infant, Newborn, Laryngoscopy economics, Laryngoscopy methods, Male, Nasopharynx pathology, Prospective Studies, Sensitivity and Specificity, Trachea pathology, Airway Obstruction complications, Airway Obstruction pathology, Respiratory Sounds etiology
- Abstract
Objective: To determine the role of airway fluoroscopy in comparison with other diagnostic modalities in diagnosing the site of partial airway obstruction in children with stridor., Design: Prospective study comparing direct laryngoscopy and bronchoscopy with nasopharyngoscopy, airway fluoroscopy, and plain films. Children with stridor or partial airway obstruction were evaluated by the Department of Otolaryngology at Columbus Children's Hospital, Columbus, Ohio. A history review and physical examination, including flexible fiberoptic laryngoscopy, plain films, airway fluoroscopy, and direct laryngoscopy and bronchoscopy, were performed for all children., Setting: Tertiary care children's hospital., Patients: From November 1996 to September 1999, 64 children aged 1 week to 12 years, with a mean age of 1.8 years and male-female ratio of 3:2, were evaluated for stridor., Main Outcome Measures: The sensitivity and specificity of airway fluoroscopy in diagnosing the site of partial airway obstruction in comparison with nasopharyngoscopy and plain films., Results: Airway fluoroscopy had a sensitivity of 80% for subglottic, 73% for tracheal, and 80% for bronchial sites of obstruction. It was less sensitive for supraglottic and glottic sites-33% and 14%, respectively. Nasopharyngoscopy was more sensitive for supraglottic and glottic sites of obstruction. Overall, airway fluoroscopy was far more sensitive than plain films for diagnosing site of obstruction., Conclusions: Airway fluoroscopy is a quick, noninvasive, and dynamic study of the entire airway that provides important additional information to the history review and physical examination and is a valuable adjunct to flexible fiberoptic laryngoscopy. It was far superior to plain films and may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway.
- Published
- 2003
- Full Text
- View/download PDF
39. Laser cordotomy versus radiotherapy: an objective cost analysis.
- Author
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Brandenburg JH
- Subjects
- Adult, Aged, Aged, 80 and over, Costs and Cost Analysis, Humans, Male, Microsurgery economics, Microsurgery methods, Middle Aged, Retrospective Studies, Treatment Outcome, Voice Disorders diagnosis, Voice Disorders etiology, Voice Quality, Carcinoma, Squamous Cell economics, Carcinoma, Squamous Cell radiotherapy, Carcinoma, Squamous Cell surgery, Glottis radiation effects, Glottis surgery, Laryngeal Neoplasms economics, Laryngeal Neoplasms radiotherapy, Laryngeal Neoplasms surgery, Laryngoscopy economics, Laryngoscopy methods, Laser Therapy economics, Laser Therapy methods
- Abstract
This study presents a cost analysis of and comparison between laser cordotomy and external beam irradiation for the treatment of early glottic carcinoma. It compares the curative results of the two modalities from data of a retrospective study at my institution and a literature review of published cure rates. It also reviews the results of objective voice assessments in cases representing both treatments. The findings of this study indicate that the cure rates are equivalent and that voice quality obtained after laser cordotomy is comparable to that obtained after irradiation, yet the total cost of external beam radiotherapy is significantly higher than that of laser surgery. Hence, the findings of this study provide strong support for initially treating early glottic tumors with laser surgery.
- Published
- 2001
- Full Text
- View/download PDF
40. Indirect laryngeal surgery in the clinical voice laboratory: the renewal of a lost art.
- Author
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Hogikyan ND and Pynnonen M
- Subjects
- Biopsy, Cost-Benefit Analysis, Humans, Larynx pathology, Retrospective Studies, Laryngeal Diseases economics, Laryngeal Diseases surgery, Laryngoscopy economics, Laryngoscopy methods
- Abstract
Since the advent of precision instruments and safe techniques for direct laryngoscopic surgery under general anesthesia, indirect laryngeal surgery has become very uncommon. A review of the recent literature finds that few authors advocate indirect surgery under topical anesthesia, and many otolaryngologists dismiss this technique as being either of only historical interest or an idiosyncratic method practiced only by a handful of clinicians. The societal mandate for cost-effective healthcare and the availability of relatively low-cost, high-quality endoscopes and video equipment warrant a renewed and broader interest in this type of surgery. In this article, we review a series of 27 indirect surgical procedures performed under topical anesthesia in the clinical voice laboratory. We discuss the indications, outcomes, advantages, and disadvantages of this surgery, and we present a brief analysis of its cost-effectiveness. We conclude that indirect laryngeal surgery in the clinical voice laboratory is an effective, safe, efficient, and less costly alternative to some procedures routinely performed under general anesthesia.
- Published
- 2000
41. The costs of intense neuromuscular block for anesthesia during endolaryngeal procedures due to waiting time.
- Author
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Puura AI, Rorarius MG, Manninen P, Hoppu S, and Baer GA
- Subjects
- Adult, Appointments and Schedules, Costs and Cost Analysis, Double-Blind Method, Electric Stimulation, Female, Humans, Male, Middle Aged, Prospective Studies, Anesthesia economics, Laryngoscopy economics, Neuromuscular Blockade, Neuromuscular Depolarizing Agents economics, Neuromuscular Nondepolarizing Agents economics
- Abstract
Unlabelled: The goal of this double-blinded, prospective study was to compare the costs incurred by waiting time of intense neuromuscular block while posttetanic count (PTC) was maintained at 0-2 during jet ventilation. Fifty patients were randomized into five groups to receive atracurium (ATR), mivacurium (MIV), rocuronium (ROC), vecuronium (VEC), and succinylcholine (SUCC). PTC < or =2 was maintained until completion of laryngomicroscopy by administering additional doses of relaxants or by adjusting the speed of the infusion of SUCC. We compared waiting time, i.e., onset time and recovery time, and costs of intense neuromuscular block. The expenses due to waiting time were calculated based on the average costs in the otorhinolaryngological operating room in Tampere University Hospital: FIM 40 (approximately $8) per minute in 1997. MIV and SUCC differ favorably from ATR, ROC, and VEC when waiting time and costs are concerned. The recovery times with MIV and SUCC were considerably shorter than those with ATR, ROC, and VEC (P < 0.001 in all pairwise comparisons). Using the muscle relaxant with the longest waiting time instead of that with the shortest waiting time (difference 21.8 min) cost more than FIM 800 (approximately $160) extra per patient., Implications: In this randomized, double-blinded, prospective study, we evaluated the costs of intense neuromuscular block due to waiting time. Succinylcholine and mivacurium are the most economical muscle relaxants to use when intense neuromuscular block is mandatory. Using intermediate-acting muscle relaxants results in unduly prolonged recovery time and extra costs.
- Published
- 1999
- Full Text
- View/download PDF
42. Computed tomography scanning of supraglottic neoplasms: its cost-effective use in preoperative staging.
- Author
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Maroldi R, Battaglia G, Maculotti P, Cabassa P, and Chiesa A
- Subjects
- Adult, Aged, Cost-Benefit Analysis, Female, Humans, Laryngeal Neoplasms economics, Laryngeal Neoplasms pathology, Laryngeal Neoplasms surgery, Laryngectomy economics, Laryngoscopy economics, Male, Middle Aged, Neoplasm Staging economics, Predictive Value of Tests, Laryngeal Neoplasms diagnostic imaging, Technology Assessment, Biomedical economics, Tomography, X-Ray Computed economics
- Published
- 1996
- Full Text
- View/download PDF
43. Indirect laryngoscopy as a screening test for laryngeal cancer.
- Author
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Taylor WC
- Subjects
- Costs and Cost Analysis, Humans, Laryngeal Neoplasms mortality, Sensitivity and Specificity, Laryngeal Neoplasms diagnosis, Laryngoscopy adverse effects, Laryngoscopy economics
- Published
- 1991
- Full Text
- View/download PDF
44. The Bullard intubating laryngoscopes.
- Author
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Bjoraker DG
- Subjects
- Equipment Design, Equipment Safety, History, 19th Century, History, 20th Century, Humans, Intubation, Intratracheal instrumentation, Laryngoscopy economics, Laryngoscopy history, Laryngoscopy methods, Technology, High-Cost, Vocal Cords, Intubation, Intratracheal methods, Laryngoscopes
- Published
- 1990
45. Health care costs of laryngeal surgery.
- Author
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Thawley SE and Ogura JH
- Subjects
- Biopsy economics, Costs and Cost Analysis, Hospitalization economics, Humans, Laryngeal Diseases surgery, Laryngectomy economics, Laryngectomy methods, Laryngoscopy economics, Laser Therapy, Neck Dissection economics, Laryngeal Diseases economics
- Abstract
The total costs of various laryngeal surgeries were considered from initial visit through one year postoperatively. For the four most widely used procedures, average costs were: laryngoscopy with biopsy, $1,000.00; hemilaryngectomy, $5,035.00; total laryngectomy $6,010.00; and supraglottic laryngectomy and neck dissection, $12,096.00. Most ancillary service charges decrease as length of hospitalization increases except for pharmacy and respiratory therapy. Physicians whose decisions affect health care should also take cognizance of health care costs.
- Published
- 1979
- Full Text
- View/download PDF
46. The practical and economic value of flexible system laryngoscopy.
- Author
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Welch AR
- Subjects
- Fiber Optic Technology, Humans, Laryngeal Diseases diagnosis, Laryngoscopes, Laryngoscopy economics, Laryngoscopy methods
- Published
- 1982
- Full Text
- View/download PDF
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