The health utility of mild and severe dysphonia

Abstract

Objectives/Hypothesis: The impact of disease states can be measured using health state utilities, which are values that reflect economic preferences for health outcomes. Utilities for dysphonia have not been studied using direct methods. The objective of this project was to establish the baseline health utilities of mild and severe dysphonia from a societal perspective.Study Design: Direct utility elicitation survey. Methods: Four health states (monocular blindness, binocular blindness, mild dysphonia, and severe dysphonia) were evaluated by a convenience sample of adults recruited from the general public with three computer-aided estimation techniques (visual analog scale [VAS], standard gamble [SG], and time trade-off [TTO]). Standardized descriptions and voice recordings from multiple dysphonic patients were employed. Perfect health was defined as a utility of 1, with death 0. Analysis of variance with post hoc pairwise comparison was used to calculate significant differences between health states.Results: Three hundred participants were surveyed, and 225 (75.0%) responses met quality thresholds. Severe dysphonia (VAS = 48.3, SG = 0.810, TTO = 0.798) was valued significantly worse than monocular blindness (VAS = 56.2, SG = 0.834, TTO = 0.839) on the VAS (P < .001) and equivalent on SG and TTO; it was preferred over binocular blindness (VAS = 25.7, SG = 0.631, TTO = 0.622; P < .001) with all methods. Mild dysphonia evaluated favorably with all methods to the other health states (VAS = 78.5, SG = 0.902, TTO = 0.908; P < .001).Conclusions: Voice disorders may have a measurable impact on utility, with severe dysphonia valued equivalently to monocular blindness. Mild dysphonia has a utility decrement from perfect health. These estimates are critical for quality-of-life assessment and could be used to assess cost-effectiveness of treatments for voice disorders.

Laryngeal complications of COVID‐19

“…Laryngeal injury and subsequent functional impairment in voice, airway, and swallowing have long been recognized as complications of prolonged intubation, regardless of the initial etiology of respiratory failure 20‐27 . These can have significant impact on health utilities and quality of life 34‐36 . Similar to prior studies about prolonged intubation, we observed patients presenting with vocal fold immobility, glottic inflammation and erythema, granulation, posterior glottic and subglottic stenosis, and posterior glottic diastasis following intubation for COVID‐19.…”

“…[20][21][22][23][24][25][26][27] These can have significant impact on health utilities and quality of life. [34][35][36] Similar to prior studies about prolonged intubation, we cohort of patients presenting for laryngological evaluation -than in these prior studies. 41,42 The glottic and subglottic level sequelae of changing patient positioning from supine to prone while intubated are currently unknown, though it is reasonable to surmise this may result in further localized trauma.…”

A visual analog scale for patient‐reported voice outcomes: The VAS voice

“…In recent years, particular attention has been given to patient‐reported outcomes (referred to variably as PROMs or PRO measures) in clinical trial design, device development, and routine medical care . These may be general measures of quality of life (eg, SF‐36 and EQ‐5D), disease‐specific measures of utility, or other disease‐specific measure designed to capture quality of life or disability. Otolaryngology, which tends to see a large percentage of quality‐of‐life complaints particularly suited to patient‐centric assessment, has likewise had an explosion of PROMs across many different subspecialties and topics, including voice …”

Voice‐Related Quality of Life in Idiopathic Subglottic Stenosis: Effect of Serial Intralesional Steroid Injections

“…For laryngologists treating benign and malignant conditions, voice outcomes are critical because they can significantly impact quality of life and health utility 6,7 . SILSI has been demonstrated to be safe, with few complications, 1,2,8 but its effect on voice is not well described.…”

“…4,5 For laryngologists treating benign and malignant conditions, voice outcomes are critical because they can significantly impact quality of life and health utility. 6,7 SILSI has been demonstrated to be safe, with few complications, 1,2,8 but its effect on voice is not well described. Most patients with ISGS have mild to no voice complaints, but several series suggests that there is improvement of voice-related patient-reported outcome measures after treatment of ISGS with dilation.…”