title: Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach.
abstract: OBJECTIVE
  Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care.
  
  
  METHODS
  Cost-benefit analysis based on contingent valuation surveys.
  
  
  METHODS
  An otolaryngology-specific ER in a tertiary care academic medical center.
  
  
  METHODS
  Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework.
  
  
  RESULTS
  The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343.
  
  
  CONCLUSIONS
  Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Matthew_Naunheim@meei.harvard.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Naunheim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Elliot D
authors.initials: ED
authors.lastname: Kozin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rosh K
authors.initials: RK
authors.lastname: Sethi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: H Gregory
authors.initials: HG
authors.lastname: Ota
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
mesh_terms: D000208:Acute Disease; D002648:Child; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010036:Otolaryngology / Q000191:economics*; D010361:Patients / Q000523:psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: contingent valuation; cost-benefit analysis; emergency services; specialty emergency rooms; willingness to pay