Cost-effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low-risk thyroid cancer patients

Evan Walgama, Gregory W. Randolph, Carol Lewis, Neil Tolley, Wendy Sacks, Yufei Chen, Allen S. Ho

Research output: Contribution to journalArticlepeer-review


Background: Flexible fiberoptic laryngoscopy is performed prior to thyroid surgery to evaluate the function of the recurrent laryngeal nerve. We assess the cost-effectiveness of preoperative laryngoscopy prior to total thyroidectomy for a low-risk thyroid cancer patient without dysphonia. Methods: A decision tree analysis was performed from a third-party payer perspective. We assessed the cost-effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for T2N0M0 papillary thyroid carcinoma, such that an ipsilateral vocal fold paralysis alters the surgical plan to hemi-thyroidectomy, when permissible, to avoid the risk of bilateral vocal fold paralysis. Results: Performing preoperative laryngoscopy to assess vocal fold function has an incremental cost-effectiveness ratio (ICER) of 45 193 USD/QALY compared to no laryngoscopy. At a willingness-to-pay of 100 K/QALY, the intervention is cost-effective if the incidence of vocal fold paralysis is at least 0.57%, or when the permissible rate of hemithyroidectomy in cases of incidental paralysis is at least 41%. Probabilistic sensitivity analysis shows that laryngoscopy is cost-effective in 90.9% of cases. Conclusions: Fiberoptic laryngoscopy is a cost-effective prior to total thyroidectomy in asymptomatic, low-risk thyroid cancer patients.

Original languageEnglish (US)
Pages (from-to)2593-2601
Number of pages9
JournalHead and Neck
Issue number9
StatePublished - Sep 1 2020


  • cost-effectiveness
  • economic evaluation
  • laryngoscopy
  • thyroid cancer
  • vocal fold paralysis

ASJC Scopus subject areas

  • Otorhinolaryngology

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