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Article: Evaluating the Cost-Effectiveness of Laryngeal Examination after Elective Total Thyroidectomy
Title | Evaluating the Cost-Effectiveness of Laryngeal Examination after Elective Total Thyroidectomy |
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Authors | |
Issue Date | 2014 |
Publisher | Springer 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? |
Abstract | Background 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 Identifier | http://hdl.handle.net/10722/202222 |
ISSN | 2021 Impact Factor: 4.339 2020 SCImago Journal Rankings: 1.764 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Lang, HHB | - |
dc.contributor.author | Wong, CKH | - |
dc.contributor.author | Tsang, RKY | - |
dc.contributor.author | Wong, KP | - |
dc.contributor.author | Wong, Birgitta Yee Hang | - |
dc.date.accessioned | 2014-08-22T02:57:49Z | - |
dc.date.available | 2014-08-22T02:57:49Z | - |
dc.date.issued | 2014 | - |
dc.identifier.citation | Annals of Surgical Oncology, 2014, v. 21 n. 11, p. 3548-3556 | - |
dc.identifier.issn | 1068-9265 | - |
dc.identifier.uri | http://hdl.handle.net/10722/202222 | - |
dc.description.abstract | Background 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.language | eng | - |
dc.publisher | Springer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.org | - |
dc.relation.ispartof | Annals of Surgical Oncology | - |
dc.rights | The final publication is available at Springer via http://dx.doi.org/10.1245/s10434-014-3770-y | - |
dc.title | Evaluating the Cost-Effectiveness of Laryngeal Examination after Elective Total Thyroidectomy | - |
dc.type | Article | - |
dc.description.nature | postprint | - |
dc.identifier.doi | 10.1245/s10434-014-3770-y | - |
dc.identifier.pmid | 24866435 | - |
dc.identifier.scopus | eid_2-s2.0-84924057938 | - |
dc.identifier.hkuros | 229117 | - |
dc.identifier.eissn | 1534-4681 | - |
dc.identifier.isi | WOS:000342144900032 | - |
dc.identifier.issnl | 1068-9265 | - |