{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T18:48:04Z","timestamp":1773773284629,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2010,11,30]],"date-time":"2010-11-30T00:00:00Z","timestamp":1291075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2011,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives\/Hypothesis:<\/jats:title><jats:p>To determine which treatment for Tis\/T1 glottic carcinoma among adult patients, transoral CO<jats:sub>2<\/jats:sub> laser excision (TOL) versus external beam radiation (XRT), is superior in terms of cost utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design:<\/jats:title><jats:p>Cost\u2010utility analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Six head\u2010to\u2010head comparison studies and 22 consecutive case series were identified to examine oncologic control. The case series were pooled as a composite group. Primary end points were local control (LC), laryngectomy\u2010free survival (LFS), and overall survival (OS). Objective and subjective voice\u2010quality measures were secondary end points. Third\u2010party payer perspective was adopted for cost\u2010utility analysis. Operational and capital costs were determined with the microcosting method. Rollback calculations and quality adjusted life years (QALYs) were calculated with decision\u2010tree modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>There were no significant differences between TOL surgery and XRT with respect to LC (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.51\u20101.3) and LFS (OR, 0.84, 95% CI, 0.42\u20101.66). The weighted mean difference for OS was 0.03. There were no objective differences for measures of voice quality. Decision\u2010tree analysis was undertaken using mean 5\u2010year local control initial probabilities. CO<jats:sub>2<\/jats:sub> laser cost $2475.65\/case (US $2407.32\/case), generating 1.663 QALYs, whereas radiation cost $4965.85\/case (US $4828.79\/case), generating 1.506 QALYs. This contrasts initial upstream costs for CO<jats:sub>2<\/jats:sub> laser (\u223c$1889\/case, \u223cUS $1836.86\/case) and radiation (\u223c$2454.70\/case, \u223cUS $2386.95\/case).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>This meta\u2010analysis shows that there is no clear difference in oncologic outcome between TOL surgery and XRT. There is a trend for improved post\u2010treatment voice quality with XRT, although the clinical significance of this is questionable. TOL surgery dominates XRT from a cost\u2010utility standpoint primarily because of the enhanced downstream affordability of salvage treatment. Laryngoscope, 2011<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.21226","type":"journal-article","created":{"date-parts":[[2010,9,13]],"date-time":"2010-09-13T18:26:31Z","timestamp":1284402391000},"page":"116-134","source":"Crossref","is-referenced-by-count":76,"title":["What treatment for early\u2010stage glottic carcinoma among adult patients: CO<sub>2<\/sub> endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility?"],"prefix":"10.1002","volume":"121","author":[{"given":"Kevin M.","family":"Higgins","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,11,30]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20009"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLG.0000199591.92336.06"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200204000-00005"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200106000-00028"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(199903)21:2<116::AID-HED4>3.0.CO;2-8"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.132.1.59"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200202000-00006"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-199916050-00007"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200220040-00003"},{"key":"e_1_2_6_11_2","first-page":"473","article-title":"How attractive does a new technology have to be to warrant adoption and utilization? 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