title: Evaluating the cost-effectiveness of laryngeal examination after elective total thyroidectomy.
abstract: BACKGROUND
  Although routine laryngeal examination (RLE) after thyroidectomy may cost more than selective laryngeal examination (SLE), it permits earlier detection and treatment of vocal cord palsy (VCP) and so may be cost-saving in the longer term. We compared the 2-year cost-effectiveness between RLE and SLE with RLE performed at 2 weeks (SLE-2w), 1 month (SLE-1m), and 3 months (SLE-3m) after thyroidectomy in the institution's perspective.
  
  
  METHODS
  Our case definition was a hypothetical 50-year-old woman who underwent an elective total thyroidectomy for a benign multinodular goiter. A decision-analytic model was constructed to compare the estimated cost-effectiveness between RLE, SLE-2w, SLE-1m, and SLE-3m after a 2-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year. Sensitivity and threshold analyses were used to examine model uncertainty.
  
  
  RESULTS
  RLE was not cost-effective because its incremental cost-effectiveness ratio to SLE-2w, SLE-1m, and SLE-3m were US$302,755, US$227,883 and US$247,105, respectively. RLE was only cost-effective when the temporary VCP rate increased >42.7 % or when the cost of RLE equaled zero. Similarly, SLE-2w was only cost-effective to SLE-3m when dysphonia for temporary VCP at 3 months increased >39.13 %, dysphonia for permanent VCP at 3 months increased >50.29 %, or dysphonia without VCP at 3 months increased >42.69 %. However, none of these scenarios appeared clinically likely.
  
  
  CONCLUSIONS
  In the institution's perspective, RLE was not cost-effective against the other three SLE strategies. Regarding to the optimal timing of SLE, SLE-3m appears to be a reasonable and acceptable strategy because of its relative low overall cost.
authors.affiliation: Department of Surgery, Division of Endocrine Surgery, University of Hong Kong, Hong Kong, SAR, China, blang@hku.hk.
authors.forename: Brian Hung-Hin
authors.initials: BH
authors.lastname: Lang
authors.forename: Carlos K H
authors.initials: CK
authors.lastname: Wong
authors.forename: Raymond K Y
authors.initials: RK
authors.lastname: Tsang
authors.forename: Kai Pun
authors.initials: KP
authors.lastname: Wong
authors.forename: Birgitta Y H
authors.initials: BY
authors.lastname: Wong
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D013964:Thyroid Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics*; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000191:economics* / Q000209:etiology