PSU11 Cost-Effective Analysis of UPPER Airway Biopses in the Outpatient Clinic Compare to Operating Room

Abstract

Larynx and pharynx biopsies are primarily performed in the operating theater. New technologies enable safe outpatient clinic biopsies (OCB) avoiding the operating theatre biopsies (OTB) and general anesthesia. We aim to identify the cost-effectiveness of OCB versus OTB. We conducted a cost-effectiveness analysis comparing OCB versus OTB in patients with suspicious lesions of larynx and pharynx in UKs national health system, along one year. The costs associated were derived from a payer’s perspective. Costs were obtained from Scottish Health Technology Group advice statement, a UK micro-costing study and NHS tariffs. We conducted a meta-analysis to obtain the tolerability and malignancy rate of outpatient biopsies. Discount rate was 3,5% as recommended by the NICE. The annuitization period was five years. The effect measure in the study was the risk of general anesthesia. We conducted a PSA and multiple deterministic sensitivity analyses to validate the robustness of the base-case. The base-case showed the total cost was £819 and £827 for OCB and OTB, respectively. Low sensibility and tolerability of the OCB, results in 58% of patients requiring a follow-up OTB. Implementing the OCB in Scotland will save £35.518/year while 913/2264 patients will avoid general anesthesia per year. The ICER is -115 making OCB cost-minimizing while decreasing the risk of general anesthesia. Extended dominance results in reusable endoscopes being dominant in the outpatient alternatives. However, the base-case result is sensitive to the number of reusable channeled rhinolaryngoscopes per site, resulting in a shift to single-use dominance as the number of reusable scopes shifts from 2 to 3 scopes per site. We found that OCB is dominant compared OTB. Further, the dominance of channeled reusable or single-use rhinolaryngoscopes is sensitive to the number of channeled rhinolaryngoscopes.