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Cost‐effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low‐risk thyroid cancer patients
Author(s) -
Walgama Evan,
Randolph Gregory W.,
Lewis Carol,
Tolley Neil,
Sacks Wendy,
Chen Yufei,
Ho Allen S.
Publication year - 2020
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.26312
Subject(s) - medicine , laryngoscopy , thyroidectomy , recurrent laryngeal nerve , surgery , thyroid cancer , paralysis , thyroid , anesthesia , intubation
Background Flexible fiberoptic laryngoscopy is performed prior to thyroid surgery to evaluate the function of the recurrent laryngeal nerve. We assess the cost‐effectiveness of preoperative laryngoscopy prior to total thyroidectomy for a low‐risk thyroid cancer patient without dysphonia. Methods A decision tree analysis was performed from a third‐party payer perspective. We assessed the cost‐effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for T2N0M0 papillary thyroid carcinoma, such that an ipsilateral vocal fold paralysis alters the surgical plan to hemi‐thyroidectomy, when permissible, to avoid the risk of bilateral vocal fold paralysis. Results Performing preoperative laryngoscopy to assess vocal fold function has an incremental cost‐effectiveness ratio (ICER) of 45 193 USD/QALY compared to no laryngoscopy. At a willingness‐to‐pay of 100 K/QALY, the intervention is cost‐effective if the incidence of vocal fold paralysis is at least 0.57%, or when the permissible rate of hemithyroidectomy in cases of incidental paralysis is at least 41%. Probabilistic sensitivity analysis shows that laryngoscopy is cost‐effective in 90.9% of cases. Conclusions Fiberoptic laryngoscopy is a cost‐effective prior to total thyroidectomy in asymptomatic, low‐risk thyroid cancer patients.