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Article: Evaluating the Cost-Effectiveness of Laryngeal Examination after Elective Total Thyroidectomy

TitleEvaluating the Cost-Effectiveness of Laryngeal Examination after Elective Total Thyroidectomy
Authors
Issue Date2014
PublisherSpringer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.org
Citation
Annals of Surgical Oncology, 2014, v. 21 n. 11, p. 3548-3556 How to Cite?
AbstractBackground Although routine laryngeal examination (RLE) after thyroidectomy may cost more than selective laryngeal examination (SLE), it permits earlier detection and treatment of vocal cord palsy (VCP) and so may be cost-saving in the longer term. We compared the 2-year cost-effectiveness between RLE and SLE with RLE performed at 2 weeks (SLE-2w), 1 month (SLE-1m), and 3 months (SLE-3m) after thyroidectomy in the institution's perspective. Methods Our case definition was a hypothetical 50-year-old woman who underwent an elective total thyroidectomy for a benign multinodular goiter. A decision-analytic model was constructed to compare the estimated cost-effectiveness between RLE, SLE-2w, SLE-1m, and SLE-3m after a 2-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year. Sensitivity and threshold analyses were used to examine model uncertainty. Results RLE was not cost-effective because its incremental cost-effectiveness ratio to SLE-2w, SLE-1m, and SLE-3m were US$302,755, US$227,883 and US$247,105, respectively. RLE was only cost-effective when the temporary VCP rate increased >42.7 % or when the cost of RLE equaled zero. Similarly, SLE-2w was only cost-effective to SLE-3m when dysphonia for temporary VCP at 3 months increased >39.13 %, dysphonia for permanent VCP at 3 months increased >50.29 %, or dysphonia without VCP at 3 months increased >42.69 %. However, none of these scenarios appeared clinically likely. Conclusions In the institution's perspective, RLE was not cost-effective against the other three SLE strategies. Regarding to the optimal timing of SLE, SLE-3m appears to be a reasonable and acceptable strategy because of its relative low overall cost. © 2014 Society of Surgical Oncology.
Persistent Identifierhttp://hdl.handle.net/10722/202222
ISSN
2015 Impact Factor: 3.655
2015 SCImago Journal Rankings: 1.902
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLang, HHB-
dc.contributor.authorWong, CKH-
dc.contributor.authorTsang, RKY-
dc.contributor.authorWong, KP-
dc.contributor.authorWong, Birgitta Yee Hang-
dc.date.accessioned2014-08-22T02:57:49Z-
dc.date.available2014-08-22T02:57:49Z-
dc.date.issued2014-
dc.identifier.citationAnnals of Surgical Oncology, 2014, v. 21 n. 11, p. 3548-3556-
dc.identifier.issn1068-9265-
dc.identifier.urihttp://hdl.handle.net/10722/202222-
dc.description.abstractBackground Although routine laryngeal examination (RLE) after thyroidectomy may cost more than selective laryngeal examination (SLE), it permits earlier detection and treatment of vocal cord palsy (VCP) and so may be cost-saving in the longer term. We compared the 2-year cost-effectiveness between RLE and SLE with RLE performed at 2 weeks (SLE-2w), 1 month (SLE-1m), and 3 months (SLE-3m) after thyroidectomy in the institution's perspective. Methods Our case definition was a hypothetical 50-year-old woman who underwent an elective total thyroidectomy for a benign multinodular goiter. A decision-analytic model was constructed to compare the estimated cost-effectiveness between RLE, SLE-2w, SLE-1m, and SLE-3m after a 2-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year. Sensitivity and threshold analyses were used to examine model uncertainty. Results RLE was not cost-effective because its incremental cost-effectiveness ratio to SLE-2w, SLE-1m, and SLE-3m were US$302,755, US$227,883 and US$247,105, respectively. RLE was only cost-effective when the temporary VCP rate increased >42.7 % or when the cost of RLE equaled zero. Similarly, SLE-2w was only cost-effective to SLE-3m when dysphonia for temporary VCP at 3 months increased >39.13 %, dysphonia for permanent VCP at 3 months increased >50.29 %, or dysphonia without VCP at 3 months increased >42.69 %. However, none of these scenarios appeared clinically likely. Conclusions In the institution's perspective, RLE was not cost-effective against the other three SLE strategies. Regarding to the optimal timing of SLE, SLE-3m appears to be a reasonable and acceptable strategy because of its relative low overall cost. © 2014 Society of Surgical Oncology.-
dc.languageeng-
dc.publisherSpringer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.org-
dc.relation.ispartofAnnals of Surgical Oncology-
dc.rightsThe final publication is available at Springer via http://dx.doi.org/10.1245/s10434-014-3770-y-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.titleEvaluating the Cost-Effectiveness of Laryngeal Examination after Elective Total Thyroidectomy-
dc.typeArticle-
dc.description.naturepostprint-
dc.identifier.doi10.1245/s10434-014-3770-y-
dc.identifier.pmid24866435-
dc.identifier.hkuros229117-
dc.identifier.eissn1534-4681-
dc.identifier.isiWOS:000342144900032-

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