Cost-effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low-risk thyroid cancer patients.
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.
['Walgama|Evan|E|0000-0003-4441-5526', 'Randolph|Gregory W|GW|', 'Lewis|Carol|C|', 'Tolley|Neil|N|', 'Sacks|Wendy|W|', 'Chen|Yufei|Y|', 'Ho|Allen S|AS|']
D003362:Cost-Benefit Analysis D006801:Humans D007828:Laryngoscopy D013964:Thyroid Neoplasms D013965:Thyroidectomy D014826:Vocal Cord Paralysis
cost-effectiveness laryngoscopy thyroid cancer vocal fold paralysis economic evaluation