Cost-Effectiveness of Depression Screening for Otolaryngology-Head and Neck Surgery Residents.

OBJECTIVES: This study aims to determine the cost-effectiveness of screening and treating otolaryngology-head and neck surgery residents for depression. METHODS: A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; Williamstown, MA) to assess the cost-effectiveness of five potential treatment algorithms: 1) treat all residents with psychotherapy, 2) screen and treat depressed residents with psychotherapy, 3) screen and treat depressed residents with pharmacotherapy, 4) screen and treat depressed residents with combination psychotherapy/pharmacotherapy, and 5) no intervention. A Monte Carlo probabilistic sensitivity analysis (PSA), consisting of 1 thousand simulations over a cumulative 5-year period, was performed to evaluate both base case values and a range of values for model variables. RESULTS: Screening residents for depression and treating with combination psychotherapy/pharmacotherapy was cost-effective and the optimal strategy at a willingness-to-pay threshold of $50 thousand per quality-adjusted life year (QALY). This option demonstrated an incremental cost-effectiveness ratio of $27,578 per QALY for base case values. PSA confirmed these results and demonstrated that screening residents for depression and treating with either combination pharmacotherapy/psychotherapy, pharmacotherapy alone, or psychotherapy alone were cost-effective options in 94.9% of simulations. CONCLUSION: Depression and burnout remain crucial issues among resident physicians. This study demonstrates that actively screening residents for depression is cost-effective. Based on these results, residency programs may consider trialing standardized depression screening protocols. LEVEL OF EVIDENCE: I and II. Laryngoscope, 131:502-508, 2021.

A Preliminary Case Report of a High-Quality Cost-effective Rigid Laryngoscopy Setup.

OBJECTIVE: To evaluate a cost-effective modified rigid laryngoscopy setup with a portable light source and high-resolution commercially available digital camera for use in smaller otolaryngology and family practice clinics. METHODS: The modified setup was used to obtain images of the larynx using both a traditional light source and a portable light source. Varying shutter speeds and ISOs were evaluated, and the optimal settings were determined for the modified setup. RESULTS: Picture quality was adequate, and the portable light source was bright enough. ISO from 640 to 1600 with shutter speeds ranging from 1/60 to 1/160 are ideal under the normal light source, while it is better to set the ISO between 4000 and 10 000 with shutter speeds from 1/60 to 1/100 under the portable light source. Picture quality was adequate with a resolution of 2768 pixels × 1848 pixels with 350 dpi × 350 dpi. CONCLUSIONS: Results show that the modified setup obtains images of adequate quality for use in the clinic. Additionally, since the larynx requires the most illumination for endoscopic imaging, a similar setup would work for imaging the ear and nose. This setup may make laryngoscopic exams more accessible to patients at smaller laryngoscopy clinics or family practice providers.