ABSTRACT
PURPOSE: The purpose of this study was to assess utility coefficients of health states following two minimally invasive surgical approaches for head and neck cancer, namely trans-oral robotic surgery and trans-oral laser microsurgery. Those utility coefficients will be later exploited in an economic evaluation study comparing the two approaches. METHODS: The above cited economic evaluation will be done from the Swiss healthcare system perspective and, as such, Swiss healthcare professionals were interviewed to elicit utility coefficients. Health states, ranging from remission to palliative care, were described using clinical vignettes. A computerized tool (UceWeb) implementing standard gamble and rating scale methods was used. RESULTS: Utility coefficients for 18 different health states were elicited with the two methods from 47 individuals, for a total of 1692 values. Elicited values varied from 0.980 to 0.213. Comparison with values elicited in previous studies show the need for population-specific elicitation, mainly for the worst health states. CONCLUSION: Herein we report health utility coefficients for the Swiss population for health states following minimally invasive trans-oral surgery. This study provides utility values that can be used not only for a specific cost-utility analysis, but also for future studies involving the same health states.
Subject(s)
Head and Neck Neoplasms , Oral Surgical Procedures , Cost-Benefit Analysis , Head and Neck Neoplasms/surgery , Humans , Quality of LifeABSTRACT
BACKGROUND: In the past few decades, a re-evaluation of treatment paradigms of head and neck cancers with a desire to spare patients the treatment-related toxicities of open surgery, has led to the development of new minimally invasive surgical techniques to improve outcomes. Besides Transoral Laser Microsurgery (TLM), a new robotic surgical technique namely Transoral Robotic Surgery (TORS) emerged for the first time as one of the two most prominent and widely used minimally invasive surgical approaches particularly for the treatment of oropharyngeal cancer, a sub-entity of head and neck cancers. Recent population-level data suggest equivalent tumor control, but different total costs, and need for adjuvant chemoradiation. A comparative analysis of these two techniques is therefore warranted from the cost-utility (C/U) point of view. METHODS: A cost-utility analysis for comparing TORS and TLM was performed using a decision-analytical model. The analyses adopted the perspective of a Swiss hospital. Two tertiary referral centers in Lausanne and Zurich provided data for model quantificantion. RESULTS: In the base case analysis TLM dominates TORS. This advantage remains robust, even if the costs for TORS reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment, whereby in an interval between 55 and 62% cost effectiveness of TORS is sensitive to the prescription of adjuvant chemoradiation therapy (CRT). Exceeding 29% of TLM patients requiring a revision of surgical margins renders TORS more cost-effective. CONCLUSION: Non-robotic endoscopic surgery (TLM) is more cost-effective than robotic endoscopic surgery (TORS) for the treatment of oropharyngeal cancers. However, this advantage is sensitive to various parameters, i.e.to the number of re-operations and adjuvant treatment.
Subject(s)
Carcinoma, Squamous Cell , Oropharyngeal Neoplasms , Robotic Surgical Procedures , Humans , Lasers , Microsurgery , Oropharyngeal Neoplasms/surgery , Treatment OutcomeABSTRACT
Congenital tracheal stenosis is a rare malformation of the fibrino-cartilaginous tracheal skeleton, frequently associated with cardiac malformations. The symptoms and the age of presentation varie according to the severity of the stenosis. There is a risk of airway obstruction. The diagnosis is based on endoscopy and surgery is usually required.
La sténose trachéale congénitale est une malformation rare du squelette fibro-cartilagineux de la trachée, fréquemment associée à des malformations cardiaques. Le tableau clinique et l'âge de présentation varient en fonction de la sévérité de la sténose. Il existe un risque d'obstruction des voies aériennes. Le diagnostic repose sur l'endoscopie et le traitement est chirurgical.
Subject(s)
Constriction, Pathologic/congenital , Constriction, Pathologic/surgery , Trachea/abnormalities , Airway Obstruction , Constriction, Pathologic/diagnosis , Humans , Trachea/surgery , Tracheal Stenosis/congenital , Tracheal Stenosis/diagnosis , Tracheal Stenosis/surgeryABSTRACT
The video Head Impulse Test (vHIT) is a new diagnostic device which, in clinical practice, can be used to evaluate the vestibular canal function in a fast and objective way by recording the movements of the eyes and the head. The medical literature makes it possible today to define the place of this device in the care of patients with vertigo.
Le video Head Impulse Test (vHIT) est un nouveau dispositif diagnostique qui, en pratique clinique, permet d'évaluer la fonction canalaire du vestibule de manière rapide et objective via l'enregistrement des mouvements des yeux et de la tête. La littérature médicale permet aujourd'hui de définir la place de ce dispositif dans la prise en charge de nos patients vertigineux.
