Alexander Gelbard
Last active: 7/30/2020

Health Care Costs and Cost-effectiveness in Laryngotracheal Stenosis.

Yin LX, Padula WV, Gadkaree S, Motz K, Rahman S, Predmore Z, Gelbard A, Hillel AT
Otolaryngol Head Neck Surg. 2019 160 (4): 679-686

PMID: 30481123 · PMCID: PMC6443425 · DOI:10.1177/0194599818815068

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.

MeSH Terms (14)

Adult Cost-Benefit Analysis Dilatation Endoscopy Female Health Care Costs Humans Laryngostenosis Male Middle Aged Quality-Adjusted Life Years Retrospective Studies Tracheal Stenosis Tracheotomy

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