Premium
Surgical management of bilateral vocal fold paralysis: A cost‐effectiveness comparison of two treatments
Author(s) -
Naunheim Matthew R.,
Song Phillip C.,
Franco Ramon A.,
Alkire Blake C.,
Shrime Mark G.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26253
Subject(s) - medicine , cordotomy , reimbursement , cost–benefit analysis , cost effectiveness , willingness to pay , cost effectiveness analysis , tracheotomy , operations management , surgery , risk analysis (engineering) , health care , ecology , psychiatry , spinal cord , economics , biology , microeconomics , economic growth
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