title: Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis.
abstract: BACKGROUND
  Medialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty.
  
  
  METHODS
  Cost minimization analysis conducted using a decision tree model.
  
  
  METHODS
  A decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events.
  
  
  RESULTS
  Sixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626.
  
  
  CONCLUSIONS
  Treatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar effectiveness, injection laryngoplasty should be strongly considered as a preferred treatment option for patients diagnosed with unilateral vocal fold paralysis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors.forename: Samantha
authors.initials: S
authors.lastname: Tam
authors.affiliation: Ivey Business School, Western University, London, ON, Canada.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors.forename: Sisira
authors.initials: S
authors.lastname: Sarma
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Siu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fung
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. leigh.sowerby@sjhc.london.on.ca.|St. Joseph's Health Care Centre, 268 Grovesnor Street, London, ON, N6A 4V2, Canada. leigh.sowerby@sjhc.london.on.ca.
authors.forename: Leigh
authors.initials: L
authors.lastname: Sowerby
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D003365:Costs and Cost Analysis; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs; D006801:Humans; D058753:Laryngoplasty / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014826:Vocal Cord Paralysis / Q000601:surgery*
keywords: Cost analysis; Injection laryngoplasty; Medialization thyroplasty; Vocal fold paralysis