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Cost benefit otolaryngology

M Chan, S Carrie
BACKGROUND: Functional endoscopic sinus surgery is a common procedure performed within otolaryngology, but it carries potential for significant life-changing complications. It is therefore essential that trainees undergo adequate training. The European Working Time Directive has led to reduced operating time for the trainee surgeon. With variable access and the cost implications associated with cadaveric specimens, simulation can be an invaluable educational resource in surgical training...
February 2018: Journal of Laryngology and Otology
Trevor D Crafts, Susan E Ellsperman, Todd J Wannemuehler, Travis D Bellicchi, Taha Z Shipchandler, Avinash V Mantravadi
Objective Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology-head and neck surgery, discusses future innovations, and explores the financial impact of these advances...
June 2017: Otolaryngology—Head and Neck Surgery
C Meller, T E Havas
BACKGROUND: Piezoelectric technology has existed for many years as a surgical tool for precise removal of soft tissue and bone. The existing literature regarding its use specifically for otolaryngology, and head and neck surgery was reviewed. METHODS: The databases Medline, the Cochrane Central Register of Controlled Trials, PubMed, Embase and Cambridge Scientific Abstracts were searched. Studies were selected and reviewed based on relevance. RESULTS: Sixty studies were identified and examined for evidence of benefits and disadvantages of piezoelectric surgery and its application in otolaryngology...
July 2017: Journal of Laryngology and Otology
Bahar Zarrabi, Karen K Burce, Stella M Seal, Scott D Lifchez, Richard J Redett, Kevin D Frick, Amir H Dorafshar, Carisa M Cooney
BACKGROUND: Rising health care costs, decreasing reimbursement rates, and changes in American health care are forcing physicians to become increasingly business-minded. Both academic and private plastic surgeons can benefit from being educated in business principles. The authors conducted a systematic review to identify existing business curricula and integrated a business principles curriculum into residency training. METHODS: The authors anonymously surveyed their department regarding perceived importance of business principles and performed a systematic literature review from 1993 to 2013 using PubMed and Embase to identify residency training programs that had designed/implemented business curricula...
May 2017: Plastic and Reconstructive Surgery
Alex T Legocki, Andrew Duffy-Peter, Andrew R Scott
Importance: A protocol for creating exceptionally low-cost 3-dimensional (3-D) maxillofacial skeletal models does not require proficiency with computer software or intensive labor. Small and less affluent centers can produce models with little loss in accuracy and clinical utility. Objectives: To highlight the feasibility and methods of introducing in-house, entry-level additive manufacturing (3-D printing) technology to otolaryngologic craniofacial reconstruction and to describe its clinical applications and limitations, including a comparison with available vendor models...
April 1, 2017: JAMA Otolaryngology—Head & Neck Surgery
Matthew R Naunheim, Phillip C Song, Ramon A Franco, Blake C Alkire, Mark G Shrime
OBJECTIVES/HYPOTHESIS: Endoscopic management of bilateral vocal fold paralysis (BVFP) includes cordotomy and arytenoidectomy, and has become a well-accepted alternative to tracheostomy. However, the costs and quality-of-life benefits of endoscopic management have not been examined with formal economic analysis. This study undertakes a cost-effectiveness analysis of tracheostomy versus endoscopic management of BVFP. STUDY DESIGN: Cost-effectiveness analysis. METHODS: A literature review identified a range of costs and outcomes associated with surgical options for BVFP...
March 2017: Laryngoscope
Matthew R Naunheim, Elliot D Kozin, Rosh K Sethi, H Gregory Ota, Stacey T Gray, Mark G Shrime
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...
October 2015: Otolaryngology—Head and Neck Surgery
Oliver Pfaar, Claus Bachert, Albrecht Bufe, Roland Buhl, Christof Ebner, Peter Eng, Frank Friedrichs, Thomas Fuchs, Eckard Hamelmann, Doris Hartwig-Bade, Thomas Hering, Isidor Huttegger, Kirsten Jung, Ludger Klimek, Matthias Volkmar Kopp, Hans Merk, Uta Rabe, Joachim Saloga, Peter Schmid-Grendelmeier, Antje Schuster, Nicolaus Schwerk, Helmut Sitter, Ulrich Umpfenbach, Bettina Wedi, Stefan Wöhrl, Margitta Worm, Jörg Kleine-Tebbe, Susanne Kaul, Anja Schwalfenberg
The present guideline (S2k) on allergen-specific immunotherapy (AIT) was established by the German, Austrian and Swiss professional associations for allergy in consensus with the scientific specialist societies and professional associations in the fields of otolaryngology, dermatology and venereology, pediatric and adolescent medicine, pneumology as well as a German patient organization (German Allergy and Asthma Association; Deutscher Allergie- und Asthmabund, DAAB) according to the criteria of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF)...
2014: Allergo Journal International
Isabel Rubie, Catherine Haighton, James O'Hara, Nikki Rousseau, Nick Steen, Deborah D Stocken, Frank Sullivan, Luke Vale, Scott Wilkes, Janet Wilson
BACKGROUND: The role of tonsillectomy in the management of adult tonsillitis remains uncertain and UK regional variation in tonsillectomy rates persists. Patients, doctors and health policy makers wish to know the costs and benefits of tonsillectomy against conservative management and whether therapy can be better targeted to maximise benefits and minimise risks of surgery, hence maximising cost-effective use of resources. NATTINA incorporates the first attempt to map current NHS referral criteria against other metrics of tonsil disease severity...
June 6, 2015: Trials
Randy M Leung, Timothy L Smith, Luke Rudmik
IMPORTANCE: For patients with epistaxis in whom initial interventions, such as anterior packing and cauterization, had failed, options including prolonged posterior packing, transnasal endoscopic sphenopalatine artery ligation (TESPAL), and embolization are available. However, it is unclear which interventions should be attempted and in which order. While cost-effectiveness analyses have suggested that TESPAL is the most responsible use of health care resources, physicians must also consider patient risk to maintain a patient-centered decision-making process...
May 1, 2015: JAMA Otolaryngology—Head & Neck Surgery
Michael D Seidman, Richard K Gurgel, Sandra Y Lin, Seth R Schwartz, Fuad M Baroody, James R Bonner, Douglas E Dawson, Mark S Dykewicz, Jesse M Hackell, Joseph K Han, Stacey L Ishman, Helene J Krouse, Sonya Malekzadeh, James Whit W Mims, Folashade S Omole, William D Reddy, Dana V Wallace, Sandra A Walsh, Barbara E Warren, Meghan N Wilson, Lorraine C Nnacheta
OBJECTIVE: Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually...
February 2015: Otolaryngology—Head and Neck Surgery
Joseph M Collaco, Angela D Aherrera, Karla J Au Yeung, Maureen A Lefton-Greif, Jeannine Hoch, Margaret L Skinner
IMPORTANCE: Children with complex respiratory and gastrointestinal disorders frequently require care from multiple pediatric subspecialists. Interdisciplinary pediatric aerodigestive clinic centers have been established at several pediatric tertiary care centers in the United States. Their effectiveness is unknown. OBJECTIVE: To determine whether an interdisciplinary approach to pediatric aerodigestive disorders reduces health care costs and burden. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review for the first 125 unique pediatric patients (median age, 1...
February 2015: JAMA Otolaryngology—Head & Neck Surgery
Seth M Cohen, Jaewhan Kim, Nelson Roy, Mark Courey
BACKGROUND: Despite the accepted role of laryngoscopy in assessing patients with laryngeal/voice disorders, controversy surrounds its timing. This study sought to determine how increased time from first primary care to first otolaryngology outpatient visit affected the health care costs of patients with laryngeal/voice disorders. METHODS: Retrospective analysis of a large, national administrative claims database was performed. Patients had an International Classification of Diseases, 9(th) Revision-coded diagnosis of a laryngeal/voice disorder; initially saw a primary care physician and, subsequently, an otolaryngologist as outpatients; and provided 6 months of follow-up data after the first otolaryngology evaluation...
April 2015: American Journal of Medicine
C Carrie Liu, Justin Lui, Elizabeth Oddone Paolucci, Luke Rudmik
OBJECTIVE: To evaluate the quality of economic evaluations published in the otolaryngology--head and neck surgery literature, which will identify methodologic weaknesses that can be improved on in future studies. A secondary objective is to identify factors that may be associated with higher quality economic evaluations. DATA SOURCES: Ovid Medline (including PubMed), Embase, and the National Health Services Economic Evaluation databases. REVIEW METHODS: A systematic search was performed of the aforementioned databases according to PRISMA guidelines...
January 2015: Otolaryngology—Head and Neck Surgery
Sidharth V Puram, Elliott D Kozin, Rosh Sethi, Blake Alkire, Daniel J Lee, Stacey T Gray, Mark G Shrime, Michael Cohen
OBJECTIVES/HYPOTHESIS: Surgical education remains an important mission of academic medical centers. Financial pressures may favor improved operating room (OR) efficiency at the expense of teaching in the OR. We aim to evaluate factors, such as resident participation, associated with duration of total OR, as well as procedural time of common pediatric otolaryngologic cases. STUDY DESIGN: Retrospective cohort study. METHODS: We reviewed resident and attending surgeon total OR and procedural times for isolated tonsillectomy, adenoidectomy, tonsillectomy with adenoidectomy (T&A), and bilateral myringotomy with tube insertion between 2009 and 2013...
April 2015: Laryngoscope
Luke Rudmik, Randy Leung
IMPORTANCE: Intractable epistaxis is a common otolaryngology emergency. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolization both provide excellent success rates, and therefore the decision to choose one over the other can be challenging. OBJECTIVE: To aid in decision making by evaluating the cost-effectiveness of TESPAL vs endovascular arterial embolization for intractable epistaxis. DESIGN, SETTING, AND PARTICIPANTS: Economic evaluation using a decision tree model with a 14-day time horizon for emergency department consultations for patients with intractable epistaxis defined as persistent bleeding despite bilateral anterior nasal packing...
September 2014: JAMA Otolaryngology—Head & Neck Surgery
Anita Konka, Jeremy Weedon, Nira A Goldstein
OBJECTIVE: To determine the cost of medical care using the Clinical Assessment Score-15 (CAS-15) scale versus polysomnography (PSG) for children with sleep-disordered breathing in terms of benefit. STUDY DESIGN: Cost-benefit analysis. SETTING: Hospital-based pediatric otolaryngology practice. SUBJECTS AND METHODS: Ninety-three patients from our original CAS-15 study were included. Four clinical measures were used and payment data were obtained...
September 2014: Otolaryngology—Head and Neck Surgery
Robin Youngs, Edward Fisher
No abstract text is available yet for this article.
February 2014: Journal of Laryngology and Otology
D Hamilton, C Hulme, L Flood, S Powell
As providers of health care, we face increasing demand on our limited, indeed diminishing, resources. Economic appraisal of our interventions means assessing the trade-off between effectiveness, efficiency and equity. When rationing becomes inevitable, calculation of utility values is a valuable decision-making tool. This paper reviews objective measures of patient benefit, such as quality of life, and focuses on their application within otolaryngology.
February 2014: Journal of Laryngology and Otology
Wen P Liu, Mahdi Azizian, Jonathan Sorger, Russell H Taylor, Brian K Reilly, Kevin Cleary, Diego Preciado
IMPORTANCE: To our knowledge, this is the first reported cadaveric feasibility study of a master-slave-assisted cochlear implant procedure in the otolaryngology-head and neck surgery field using the da Vinci Si system (da Vinci Surgical System; Intuitive Surgical, Inc). We describe the surgical workflow adaptations using a minimally invasive system and image guidance integrating intraoperative cone beam computed tomography through augmented reality. OBJECTIVE: To test the feasibility of da Vinci Si-assisted cochlear implant surgery with augmented reality, with visualization of critical structures and facilitation with precise cochleostomy for electrode insertion...
March 2014: JAMA Otolaryngology—Head & Neck Surgery
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