Upfront Sialendoscopy Is a Cost-Effective Option for RAIS

How cost-effective is upfront sialendoscopy compared to multiple modalities of diagnostic radiography and medical management as a diagnostic and therapeutic option for radioiodine-induced sialadenitis (RAIS)?

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

Background: Traditional RAIS management consists of medical therapy (gland massage, warm compresses, over-the-counter sialagogues) and prescription medications (antibiotics and oral steroids). Over the past 10 years, sialendoscopy has become an alternative in RAIS diagnosis and treatment, but no economic analysis compared to medical therapy alone has been performed to date.

Study design: Literature review and cost-effectiveness analysis.

Setting: Twenty-one studies from the PubMed Database; University of Mississippi Budget Office data.

Synopsis: A willingness-to-pay threshold of $50,000 was chosen for this study. The total cost of the medical management–ultrasound was $1,776.11, with an efficacy of 0.53. The 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 or medical management–MR sialography cost-effective options. Upfront sialendoscopy had an incremental cost-effectiveness ratio of $30,402.30 compared to medical management–ultrasound.

Multiple, one-way sensitivity analyses were performed on the six most influential variables in the model. The probability of sialendoscopic improvement was the most sensitive in the model, requiring a threshold of 0.70 to remain cost-effective. A probabilistic sensitivity analysis demonstrated that the probability of upfront sialendoscopy being more cost-effective at a willingness-to-pay threshold of $50,000 was 64.5%. Limitations included a limited number of studies that solely addressed patients with RAIS and the various diagnostic and treatment options, and the fact that CT and MR sialography are highly specialized and may not be available outside of large, academic medical centers.

Citation: Kowalczyk DM, Jordan JR, Stringer SP. Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis [published online ahead of print March 30, 2018]. Laryngoscope. doi: 10.1002/lary.27182.