{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:09:18Z","timestamp":1747148958426,"version":"3.40.5"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T00:00:00Z","timestamp":1591574400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Flexible fiberoptic laryngoscopy is performed prior to thyroid surgery to evaluate the function of the recurrent laryngeal nerve. We assess the cost\u2010effectiveness of preoperative laryngoscopy prior to total thyroidectomy for a low\u2010risk thyroid cancer patient without dysphonia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A decision tree analysis was performed from a third\u2010party payer perspective. We assessed the cost\u2010effectiveness 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\u2010thyroidectomy, when permissible, to avoid the risk of bilateral vocal fold paralysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Performing preoperative laryngoscopy to assess vocal fold function has an incremental cost\u2010effectiveness ratio (ICER) of 45\u2009193 USD\/QALY compared to no laryngoscopy. At a willingness\u2010to\u2010pay of 100\u2009K\/QALY, the intervention is cost\u2010effective 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\u2010effective in 90.9% of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fiberoptic laryngoscopy is a cost\u2010effective prior to total thyroidectomy in asymptomatic, low\u2010risk thyroid cancer patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.26312","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T14:41:55Z","timestamp":1591627315000},"page":"2593-2601","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost\u2010effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low\u2010risk thyroid cancer patients"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4441-5526","authenticated-orcid":false,"given":"Evan","family":"Walgama","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2014Head and Neck Surgery Cedars\u2010Sinai Medical Center  Los Angeles, California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory W.","family":"Randolph","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Surgical Oncology, Department of Surgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Tolley","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head &amp; Neck Surgery St Mary's Hospital, Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Sacks","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology Cedars\u2010Sinai Medical Center  Los Angeles, California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yufei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Endocrine Surgery Cedars\u2010Sinai Medical Center  Los Angeles, California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen S.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2014Head and Neck Surgery Cedars\u2010Sinai Medical Center  Los Angeles, California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,6,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2010.1632"},{"key":"e_1_2_6_3_1","unstructured":"Ho Allen. 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