Transoral robotic surgery and the unknown primary: A cost-effectiveness analysis

James Kenneth Byrd, Kenneth J. Smith, John R. De Almeida, William Greer Albergotti, Kara S. Davis, Seungwon W. Kim, Jonas T. Johnson, Robert L. Ferris, Umamaheswar Duvvuri

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective. To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). Study Design. Case series with chart review. Setting. Tertiary academic hospital. Subjects and Methods. A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in×strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. Results. In total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4%). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was 8619 and 5774 per additional primary identified, respectively. Conclusion. Sequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of 8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed.

Original languageEnglish (US)
Pages (from-to)976-982
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume150
Issue number6
DOIs
StatePublished - Jan 1 2014

Fingerprint

Robotics
Cost-Benefit Analysis
Tongue
Tertiary Care Centers
Squamous Cell Carcinoma
Tonsillectomy
Fees and Charges
Hospital Costs
Palatine Tonsil
Information Systems
Endoscopy
Inpatients
Neoplasms
Neck
Anesthesia
Head
Physicians
Costs and Cost Analysis

Keywords

  • Costeffectiveness analysis
  • Occult primary
  • TORS
  • Transoral robotic surgery

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Transoral robotic surgery and the unknown primary : A cost-effectiveness analysis. / Byrd, James Kenneth; Smith, Kenneth J.; De Almeida, John R.; Albergotti, William Greer; Davis, Kara S.; Kim, Seungwon W.; Johnson, Jonas T.; Ferris, Robert L.; Duvvuri, Umamaheswar.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 150, No. 6, 01.01.2014, p. 976-982.

Research output: Contribution to journalArticle

Byrd, James Kenneth ; Smith, Kenneth J. ; De Almeida, John R. ; Albergotti, William Greer ; Davis, Kara S. ; Kim, Seungwon W. ; Johnson, Jonas T. ; Ferris, Robert L. ; Duvvuri, Umamaheswar. / Transoral robotic surgery and the unknown primary : A cost-effectiveness analysis. In: Otolaryngology - Head and Neck Surgery (United States). 2014 ; Vol. 150, No. 6. pp. 976-982.
@article{ccddd16e0ebe4a1babcacd8fef0ba1e3,
title = "Transoral robotic surgery and the unknown primary: A cost-effectiveness analysis",
abstract = "Objective. To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). Study Design. Case series with chart review. Setting. Tertiary academic hospital. Subjects and Methods. A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in×strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. Results. In total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4{\%}). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was 8619 and 5774 per additional primary identified, respectively. Conclusion. Sequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of 8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed.",
keywords = "Costeffectiveness analysis, Occult primary, TORS, Transoral robotic surgery",
author = "Byrd, {James Kenneth} and Smith, {Kenneth J.} and {De Almeida}, {John R.} and Albergotti, {William Greer} and Davis, {Kara S.} and Kim, {Seungwon W.} and Johnson, {Jonas T.} and Ferris, {Robert L.} and Umamaheswar Duvvuri",
year = "2014",
month = "1",
day = "1",
doi = "10.1177/0194599814525746",
language = "English (US)",
volume = "150",
pages = "976--982",
journal = "Otolaryngology - Head and Neck Surgery (United States)",
issn = "0194-5998",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Transoral robotic surgery and the unknown primary

T2 - A cost-effectiveness analysis

AU - Byrd, James Kenneth

AU - Smith, Kenneth J.

AU - De Almeida, John R.

AU - Albergotti, William Greer

AU - Davis, Kara S.

AU - Kim, Seungwon W.

AU - Johnson, Jonas T.

AU - Ferris, Robert L.

AU - Duvvuri, Umamaheswar

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objective. To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). Study Design. Case series with chart review. Setting. Tertiary academic hospital. Subjects and Methods. A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in×strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. Results. In total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4%). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was 8619 and 5774 per additional primary identified, respectively. Conclusion. Sequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of 8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed.

AB - Objective. To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). Study Design. Case series with chart review. Setting. Tertiary academic hospital. Subjects and Methods. A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in×strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. Results. In total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4%). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was 8619 and 5774 per additional primary identified, respectively. Conclusion. Sequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of 8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed.

KW - Costeffectiveness analysis

KW - Occult primary

KW - TORS

KW - Transoral robotic surgery

UR - http://www.scopus.com/inward/record.url?scp=84903541626&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903541626&partnerID=8YFLogxK

U2 - 10.1177/0194599814525746

DO - 10.1177/0194599814525746

M3 - Article

C2 - 24618502

AN - SCOPUS:84903541626

VL - 150

SP - 976

EP - 982

JO - Otolaryngology - Head and Neck Surgery (United States)

JF - Otolaryngology - Head and Neck Surgery (United States)

SN - 0194-5998

IS - 6

ER -