CT Neck Scans Are Cost-Effective Diagnostic Tools for UVFP

How cost-effective is routine computed tomography (CT) in individuals with unilateral vocal fold paralysis (UVFP)?

Bottom line
There is strong support for CT neck scans being a cost-effective diagnostic tool for patients with newly diagnosed UVFP.

Background: Our understanding of etiologies and therapeutic approaches for UVFP has evolved over the past century, but questions remain regarding the appropriate diagnostic workup for undifferentiated UVFP. Economic evaluation is especially important in the current healthcare environment, characterized by the practice of defensive medicine and the concurrent and often contradictory increasing service utilization.

Study design: Health Economics Decision Tree Analysis restricted to vocal fold paralysis of data extracted from previous published studies.

Setting: Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Mich.

Synopsis: The primary outcome for this study was the incremental cost-effectiveness ratio (ICER) for a CT neck scan, calculated based on the decision tree. The cost of the initial decision to perform a CT neck scan versus no imaging was $624 and $128, with an effectiveness of 1 and 0.85, respectively. The ICER of pursuing a CT neck scan was $3,306, which was significantly below the acceptable willingness-to-pay (WTP) thresholds of $30,000 and $50,000. Univariate sensitivity analysis showed that at a $30,000 WTP threshold, getting a CT neck scan was more cost-effective when the incidence of abnormal pathology is above 1.7%. At the economical threshold of $30,000, a CT scan was also more cost-effective than no imaging. Limitations included a focus on the cost of a CT neck scan only, and that the evaluation was done regarding idiopathic UVFP.

Citation: Hojjat H, Svider PF, Folbe AJ, et. al. Cost-effectiveness of routine computed tomography in the evaluation of idiopathic unilateral vocal fold paralysis. Laryngoscope. 2017;127:440–444.