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Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments.
- Source :
-
The Laryngoscope [Laryngoscope] 2017 Mar; Vol. 127 (3), pp. 691-697. Date of Electronic Publication: 2016 Aug 31. - Publication Year :
- 2017
-
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.<br />Study Design: Cost-effectiveness analysis.<br />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.<br />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.<br />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.<br />Level of Evidence: NA Laryngoscope, 127:691-697, 2017.<br /> (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)
- Subjects :
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 1531-4995
- Volume :
- 127
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Laryngoscope
- Publication Type :
- Academic Journal
- Accession number :
- 27578299
- Full Text :
- https://doi.org/10.1002/lary.26253