Reconstruction After Salvage Total Laryngectomy: A Cost-effectiveness Analysis.
Otolaryngol Head Neck Surg
; 164(1): 139-145, 2021 01.
Article
in En
| MEDLINE
| ID: mdl-32660337
ABSTRACT
OBJECTIVE:
To determine the most cost-effective reconstruction method after salvage total laryngectomy. STUDYDESIGN:
Cost-effectiveness analysis.SETTING:
Tertiary care hospitals with head and neck oncologic and reconstructive surgeons. SUBJECTS ANDMETHODS:
We constructed a Markov-based decision model to compare reconstruction by primary closure to pectoralis flap and free flap after salvage total laryngectomy. The model simulated disease with transition probabilities and health utilities found in primary literature and estimated the average overall cost of each reconstructive method using Medicare billing codes. Effectiveness was compared using quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were performed to scrutinize the conclusions of our model. Reconstruction methods were compared using incremental cost-effectiveness ratios (ICERs). In the United States, less than $150,000 per QALY gained is considered cost-effective (2019 US dollars).RESULTS:
Our base case analysis revealed that primary closure was less expensive ($44,370) and yielded more QALYs (0.91) than both pectoralis ($45,163, 0.81 QALYs) and free flap ($46,244, 0.85 QALYs), making it the most cost-effective option. Between flaps, free flap was cost-effective over pectoralis flap (ICER = $27,025/QALY gained). Sensitivity analyses showed primary closure as cost-effective 69% of the time over either flap. These conclusions were sensitive to the health utilities (quality of life) of each method of reconstruction.CONCLUSION:
Tissue flaps to augment closure after salvage total laryngectomy are not always the most cost-effective reconstructive option. The long-term morbidity of flap surgery oftentimes outweighs the benefit of lowering fistula rates after surgery. Careful consideration must be taken when advising patients of their reconstructive options.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Laryngeal Neoplasms
/
Medicare
/
Salvage Therapy
/
Plastic Surgery Procedures
/
Laryngectomy
Type of study:
Health_economic_evaluation
/
Prognostic_studies
Aspects:
Patient_preference
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Otolaryngol Head Neck Surg
Journal subject:
OTORRINOLARINGOLOGIA
Year:
2021
Document type:
Article
Affiliation country: