Health Care Costs and Cost-effectiveness in Laryngotracheal Stenosis

Linda X. Yin, William V. Padula, Shekhar Gadkaree, Kevin Motz, Sabrina Rahman, Zachary Predmore, Alexander Gelbard, Alexander T. Hillel

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)679-686
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume160
Issue number4
DOIs
StatePublished - Apr 1 2019

Keywords

  • cost
  • cost-effectiveness
  • incremental cost-effectiveness ratio
  • laryngotracheal stenosis
  • subglottic stenosis

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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