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Naunheim MR, Kozin ED, Sethi RK, Ota HG, Gray ST, Shrime MG. Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach. Otolaryngol Head Neck Surg 2015. [PMID: 26216886 DOI: 10.1177/0194599815596742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES 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. STUDY DESIGN Cost-benefit analysis based on contingent valuation surveys. SETTING An otolaryngology-specific ER in a tertiary care academic medical center. SUBJECTS AND 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. CONCLUSION 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.
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Affiliation(s)
- Matthew R Naunheim
- 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
| | - Elliot D Kozin
- 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
| | - Rosh K Sethi
- 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
| | - H Gregory Ota
- 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
| | - Stacey T Gray
- 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
| | - Mark G Shrime
- 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
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Fang HY, Hsiao FY, Huang HC, Lin YS, Chen CY, Shieh SH, Chen PR, Chen CK, Chien CR. Cost and effectiveness of video-assisted thoracoscopic surgery for clinical stage I non-small cell lung cancer: a population-based analysis. J Thorac Dis 2015; 6:1690-6. [PMID: 25589961 DOI: 10.3978/j.issn.2072-1439.2014.10.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/25/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is a minimally invasive alternative to conventional surgery (CS). We aimed to estimate the short-term cost-effectiveness of VATS vs. CS for clinical stage I non-small cell lung cancer (NSCLC-c-stage-I) patients from the payer's perspective (National Health Insurance). METHODS We identified NSCLC-c-stage-I patients diagnosed and received surgery within 2007-2009 through a comprehensive population-based database containing cancer and death registries, and reimbursement data. The duration of interest was 1 year. We included potential confounding covariables through literature searching and our own experience, and used a propensity score to construct a 1:1 population for adjustment. RESULTS Our study population constituted 966 patients. The mean hospital stay [days, standard deviation (SD)] were 14.4 [7] and 16.1 (7.7) for VATS and CS respectively (P=0.002). The mean cost (2013 USD) and survival (year) was $22,316 vs. $21,976 and 0.98 vs. 0.974 for VATS vs. CS. The probability for VATS to be cost-effective (i.e., positive net benefit) was 0.49 & 0.56 at willingness-to-pay (WTP) 50,000 & 100,000 USD/life-year, respectively. CONCLUSIONS We provide the first empirical evidence that when compared to CS, VATS was potentially cost-effective in the short term (1 year) within the common WTP levels in Taiwan.
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Affiliation(s)
- Hsin-Yuan Fang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Fei-Yuan Hsiao
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Hsu-Chih Huang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Sen Lin
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yi Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Shwn-Huey Shieh
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Pin-Ru Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chein-Kuang Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ru Chien
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
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