Health Care Costs and Cost-effectiveness in Laryngotracheal Stenosis

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.

Keywords: cost; cost-effectiveness; incremental cost-effectiveness ratio; laryngotracheal stenosis; subglottic stenosis.

Figure 1.

Markov model. Patients are assumed to be in one of the discrete health states. “Procedure” represents cricotracheal/tracheal resection or endoscopic dilation. Transition probabilities between health states are summarized in Supplemental Table S1 (available in the online version of the article).

Figure 2.

Quality-adjusted life year (QALY) differences over time. Over a 10-year horizon, cricotracheal/tracheal resection led to many more quality-adjusted life years versus endoscopic dilations. The area under the curve represents the cumulative QALYs gained by cricotracheal/tracheal resection over endoscopic dilations over 10 years.