Cost‐effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low‐risk thyroid cancer patients

Abstract

Background Flexible fiberoptic laryngoscopy is performed prior to thyroid surgery to evaluate the function of the recurrent laryngeal nerve. We assess the cost‐effectiveness of preoperative laryngoscopy prior to total thyroidectomy for a low‐risk thyroid cancer patient without dysphonia. Methods A decision tree analysis was performed from a third‐party payer perspective. We assessed the cost‐effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for T2N0M0 papillary thyroid carcinoma, such that an ipsilateral vocal fold paralysis alters the surgical plan to hemi‐thyroidectomy, when permissible, to avoid the risk of bilateral vocal fold paralysis. Results Performing preoperative laryngoscopy to assess vocal fold function has an incremental cost‐effectiveness ratio (ICER) of 45 193 USD/QALY compared to no laryngoscopy. At a willingness‐to‐pay of 100 K/QALY, the intervention is cost‐effective if the incidence of vocal fold paralysis is at least 0.57%, or when the permissible rate of hemithyroidectomy in cases of incidental paralysis is at least 41%. Probabilistic sensitivity analysis shows that laryngoscopy is cost‐effective in 90.9% of cases. Conclusions Fiberoptic laryngoscopy is a cost‐effective prior to total thyroidectomy in asymptomatic, low‐risk thyroid cancer patients.

The Concept of Economic Evaluation and Its Application in Thyroid Cancer Research

“…A study published in 2020 conducted CUA for fiberoptic laryngoscopy prior to total thyroidectomy in low-risk thyroid cancer patients (T2N0M0 PTC) based on a decision model for 30 years ( Table 2 ) [ 29 ]. The study only considered direct costs, which were converted into 2019 direct costs according to public expense data (Medicare) and the literature with a 3% discount rate.…”

“…The first points to consider are direct, indirect, and intangible costs [21]. Most previous studies used direct costs, but some studies also used complication costs, the value of death, and indirect costs [26][27][28][29][30]. Previous thyroid cancer studies used discount rates of 3% to 6%, although there were variations across countries and research periods.…”

“…Previous thyroid cancer studies used discount rates of 3% to 6%, although there were variations across countries and research periods. Costs were most commonly obtained from public expenditure databases such as Medicare or the previous literature, and the probabilities of outcomes according to interventions were derived from previous studies [26][27][28][29][30]. For the economic evaluation analyses, decision tree or Markov models were applied as hypothetical models.…”

Laryngology Outcomes Following Implantable Vagus Nerve Stimulation

“…Studies have shown that vocal fold paralysis cannot always be determined based on voice symptoms. 20,21 Without preoperative laryngeal assessment there is no ability to differentiate preexisting vocal fold paralysis from vocal fold paralysis caused by VNS surgery. Recognizing vocal fold paralysis before VNS surgery would also be valuable for preoperative surgical planning and for discussing the risk of laryngeal complications with patients.…”

“…However, the value of reoperating was found to be difficult to determine without a preoperative evaluation. Studies have shown that vocal fold paralysis cannot always be determined based on voice symptoms . Without preoperative laryngeal assessment there is no ability to differentiate preexisting vocal fold paralysis from vocal fold paralysis caused by VNS surgery.…”