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Otolaryngol Head Neck Surg. 2019 Apr;160(4):679-686. doi: 10.1177/0194599818815068. Epub 2018 Nov 27.

Health Care Costs and Cost-effectiveness in Laryngotracheal Stenosis.

Author information

1
1 Department of Otorhinolaryngology, School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota, USA.
2
2 Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
3
3 Massachusetts Eye and Ear Infirmary, Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
4
4 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
5
5 Department of Otolaryngology, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
6
6 North American Airway Collaborative, Nashville, Tennessee, USA.

Abstract

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.

KEYWORDS:

cost; cost-effectiveness; incremental cost-effectiveness ratio; laryngotracheal stenosis; subglottic stenosis

PMID:
30481123
PMCID:
PMC6443425
[Available on 2020-04-01]
DOI:
10.1177/0194599818815068
[Indexed for MEDLINE]

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