Cost-Effectiveness of Steroids for Prolonging the Surgery-Free Interval in Subglottic Stenosis

• Published in: The Laryngoscope Vol. 133; no. 12; pp. 3436 - 3442
• Main Authors: Langlie, Jake A, Pasick, Luke J, Rosow, David E
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-12-2023
• Subjects: Constriction, Pathologic - complications; Cost-Benefit Analysis; Humans; Injections, Intralesional; Laryngostenosis - etiology; Retrospective Studies; Steroids - therapeutic use; Systematic review; Systematic Reviews as Topic; Treatment Outcome; cost-effectiveness; adjuvant therapy; endoscopic dilation; steroid injections; serial intralesional; subglottic stenosis
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30800

Repeat endoscopic dilation (ED) in the operating room for subglottic stenosis (SGS) remains an economic burden to patients. The cost-effectiveness (CE) of adjuvant serial intralesional steroid injections (SILSI) to prolong the surgery-free interval (SFI) in SGS patients requiring ED has yet to be studied.
Details of the cost of SILSI and ED were received from our tertiary academic center. SFI, cost of intervention, and the effect of SILSI on prolonging SFI were collected from a systematic review by Luke et al. SGS etiologies in the review included idiopathic, iatrogenic, or autoimmune. A break-even analysis, comparing the cost of SILSI alone with the cost of repeat ED, was performed to determine if SILSI injections were cost-effective in prolonging the SFI.
Average extension of the SFI with SILSI was an additional 219.3 days compared to ED alone based on a systematic review of the literature. 41/55 (74.5%) cases did not require further ED once in-office SILSI management began. SILSI administered in a 4-dose series in 3-to-7-week intervals (~$7,564.00) is CE if the reported recurrence rate of SGS requiring ED (~$39,429.00) has an absolute risk reduction (ARR) of at least 19.18% with the use of SILSI. Based on the literature, SILSI prevents ~3 out of every 4 cases of SGS at sufficient follow-up from undergoing repeat ED, resulting in an ARR of ~75%.
SILSI is economically reasonable if it prolongs the SFI of at least one case of recurrence out of 5. SILSI, therefore, can be CE in extending the interval for surgical ED.
NA Laryngoscope, 133:3436-3442, 2023.