title: Office-based narrow band imaging-guided flexible laryngoscopy tissue sampling: A cost-effectiveness analysis evaluating its impact on Taiwanese health insurance program.
abstract: OBJECTIVE
  Narrow band imaging (NBI)-guided flexible laryngoscopy tissue sampling for laryngopharyngeal lesions is a novel technique. Patients underwent the procedure in an office-based setting without being sedated, which is different from the conventional technique performed using direct laryngoscopy. Although the feasibility and effects of this procedure were established, its financial impact on the institution and Taiwanese National Health Insurance program was not determined.
  
  
  METHODS
  This is a retrospective case-control study. From May 2010 to April 2011, 20 consecutive patients who underwent NBI flexible laryngoscopy tissue sampling were recruited. During the same period, another 20 age-, sex-, and lesion-matched cases were enrolled in the control group. The courses for procedures and financial status were analyzed and compared between groups.
  
  
  RESULTS
  Office-based NBI flexible laryngoscopy tissue sampling procedure took 27 minutes to be completed, while 191 minutes were required for the conventional technique. Average reimbursement for each case was New Taiwan Dollar (NT$)1264 for patients undergoing office-based NBI flexible laryngoscopy tissue sampling, while NT$10,913 for those undergoing conventional direct laryngoscopy in the operation room (p < 0.001). The institution suffered a loss of at least NT$690 when performing NBI flexible laryngoscopy tissue sampling.
  
  
  CONCLUSIONS
  Office-based NBI flexible laryngoscopy tissue sampling is a cost-saving procedure for patients and the Taiwanese National Health Insurance program. It also saves the procedure time. However, the net financial loss for the institution and physician would limit its popularization unless reimbursement patterns are changed.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: fang3109@cgmh.org.tw.
authors.forename: Tuan-Jen
authors.initials: TJ
authors.lastname: Fang
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.affiliation: Graduate School of Management, Ming Chung University, Taipei, Taiwan.
authors.forename: Hui-Chen
authors.initials: HC
authors.lastname: Chiang
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: I-How
authors.initials: IH
authors.lastname: Chen
mesh_terms: D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007828:Laryngoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000191:economics*; D009313:National Health Programs / Q000592:standards*; D012189:Retrospective Studies; D013624:Taiwan
keywords: cost effectiveness; laryngoscopy; narrow band imaging; office-based procedure; reimbursement