Sialendoscopy More Cost-Effective than Medical Management with Diagnostic Ultrasound for RAIS

How does upfront sialendoscopy compare to multiple modalities of diagnostic radiography along with medical management for diagnosis and therapy of radioiodine-induced sialadenitis (RAIS)?

Bottom line
Upfront sialendoscopy is more cost effective compared with medical management utilizing diagnostic ultrasound, assuming a willingness-to-pay threshold of $50,000. There is a clear cost effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS.

Background: RAIS is often a chronic, recurring condition that can present within days of treatment for thyroid conditions. Diagnosis is clinical and relies primarily on reported symptoms. Traditional management consists of medical therapy, over-the-counter sialagogues, and prescription medications. Sialendoscopy is a diagnosis and treatment alternative, but there has been no economic analysis to date.

Study design: Literature review and cost-effectiveness analysis.

Setting: 21 studies from the PubMed database; information from the University of Mississippi Budget Office, Oxford.

Synopsis: A willingness-to-pay threshold of $50,000 per quality-adjusted life-year (QALY) was chosen for this study. Total cost of the medical management–ultrasound was $1,776.11, with an efficacy of 0.53. Total cost of upfront sialendoscopy was $5,937.40, with an efficacy of 0.66. A willingness-to-pay threshold of >$90,000 would be required to consider medical management–CT sialography and medical management–MR sialography as a cost-effective option. In a multiple, one-way sensitivity analysis on the six most-influential variables, the probability of sialendoscopic improvement was the most sensitive, requiring a threshold of 0.70 to remain cost effective; complication costs from sialendoscopy and medical management were the least sensitive. In a probabilistic sensitivity analysis using a Monte Carlo simulation of 1,000 trials, the probability of upfront sialendoscopy being more cost-effective at a willingness-to-pay threshold of $50,000 was 64.5%.

Citation: Kowalczyk DM, Jordan JR, Stringer SP. Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis. Laryngoscope. 2018;128:1822–1828.