Journal
OTOLARYNGOLOGY-HEAD AND NECK SURGERY
Volume 160, Issue 4, Pages 679-686Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0194599818815068
Keywords
cost; incremental cost-effectiveness ratio; cost-effectiveness; laryngotracheal stenosis; subglottic stenosis
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Funding
- AHRQ HHS [T32 HS000029] Funding Source: Medline
- NHLBI NIH HHS [R01 HL146401] Funding Source: Medline
- NIDCD NIH HHS [K23 DC014082, R21 DC017225] Funding Source: Medline
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Objective Laryngotracheal stenosis (LTS) is resource-intensive disease. The cost-effectiveness of LTS treatments has not been adequately explored. We aimed to conduct a cost-effectiveness analysis comparing open reconstruction (cricotracheal/tracheal resection [CTR/TR]) with endoscopic dilation in the treatment of LTS. Study Design Retrospective cohort. Setting Tertiary referral center (2013-2017). Subjects and Methods Thirty-four LTS patients were recruited. Annual costs were derived from the Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University. Cost-effectiveness analysis compared CTR/TR versus endoscopic dilation at a willingness-to-pay threshold of $50,000 per quality-adjusted life year (QALY) over 5- and 10-year time horizons. The incremental cost-effectiveness ratio (ICER) was calculated with deterministic analysis and tested for sensitivity with univariate and probabilistic sensitivity analysis. Results Mean LTS costs were $4080.09 (SE, $569.29) annually for related health care visits. The major risk factor for increased cost was etiology of stenosis. As compared with idiopathic patients, patients with intubation-related stenosis had significantly higher annual costs ($5286.56 vs $2873.62, P = .03). The cost of CTR/TR was $8583.91 (SE, $2263.22). Over a 5-year time horizon, CTR/TR gained $896 per QALY over serial dilations and was cost-effective. Over a 10-year time horizon, CTR/TR dominated dilations with a lower cost and higher QALY. Conclusion The cost of treatment for LTS is significant. Patients with intubation-related stenosis have significantly higher annual costs than do idiopathic patients. CTR/TR contributes significantly to cost in LTS but is cost-effective versus endoscopic dilations for appropriately selected patients over a 5- and 10-year horizon.
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